Predictors of High Costs of Care among Otolaryngology Patients

Abstract

Objectives Identify predictors of high-cost otolaryngology care. Study Design Cross-sectional. Setting Tertiary academic multispecialty hospital. Subjects/Methods All patients undergoing ≥1 otolaryngologic procedures from 2011 to 2015. Encounter costs were standardized using previously described methods approximating Medicare reimbursement. Patients were stratified by adult/pediatric and inpatient/outpatient. “Outliers” were defined as total encounter costs ≥95th percentile. Logistic regression measured predictors of outlier status. Results In total, 2433 adult inpatient encounters (95th percentile $57,611), 10,031 adult outpatient encounters ($10,772), 346 pediatric inpatient encounters ($84,639), and 3027 pediatric outpatient encounters ($8978) were included. For adult inpatient and outpatient, isolated head and neck oncologic procedures were the reference group. Among adult inpatients, laryngology and facial plastics procedures predicted higher odds of outlier status (odds ratio [OR] = 4.1 and 7.2). Involvement of multiple otolaryngology subspecialties increased the odds (OR = 4.7). Neck dissection and reconstructive procedures were the most common primary operations for adult inpatient outliers. For adult outpatients, several subspecialties had lower odds than head and neck (OR ≤0.44). Increased comorbidities predicted outliers for adult inpatient care (OR = 1.5); sex, age, race, and ethnicity did not. Cochlear implant was the most common primary operation among adult and pediatric outpatient outliers. Greater subspecialty involvement and increasing age predicted pediatric outpatient outliers (OR = 8.0 and 1.1); younger age and female sex predicted pediatric inpatient outliers (OR = 0.8 and 3.5). Airway procedures dominated pediatric inpatient outliers. Conclusion This is the first large-scale study of high-cost otolaryngology care across multiple subspecialties. Specific procedures and subspecialties and increased comorbidities predicted high-cost care. Contrary to previous studies, patient sex, race, and ethnicity did not.

Effects of Social Determinants of Health Care on Pediatric Thyroid Cancer Outcomes in the United States

“…This study did not find predictors affecting patient follow‐through on recommended surgery, a finding seen in other diseases 19,65–67 . At our institution, race/ethnicity is not associated with increased costs of surgical otolaryngology care 68 …”

“…19,[65][66][67] At our institution, race/ethnicity is not associated with increased costs of surgical otolaryngology care. 68…”

Patient Profiles and Cost of Otolaryngologic Surgeries in an LMIC Country

“…In a study by Balakrishnan et al, procedures performed under the Facial Plastic service (same as our CMFS) may predict higher cost of care compared to other subspecialties. 18 The provision of the hospital with these expensive implants have made it more accessible to more patients especially those belonging in the lowest income status who are mostly the subset affected by facial fractures from vehicular crash or trauma. 19 , 20…”

Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits

“…In a similar vein, regional Medicare expenditures for otolaryngology services vary widely and are strongly correlated with provider and hospital factors rather than clinical volume or population factors. 21,22 As a result, we chose a different method to approximate regional demand.…”

“…Therefore, the distribution of the supply of otolaryngologists should not be considered an accurate representation of the distribution of demand. In a similar vein, regional Medicare expenditures for otolaryngology services vary widely and are strongly correlated with provider and hospital factors rather than clinical volume or population factors 21 , 22 . As a result, we chose a different method to approximate regional demand.…”