Rhinology Medicare reimbursements have not been keeping up with inflation

Abstract

Background Studies have suggested that physicians are steadily being paid less per Medicare service over time based on inflation‐adjusted dollars. The objective of this study was to determine whether this phenomenon was true for rhinologic procedures. Methods This study was a retrospective analysis of the 2000‐2021 Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule investigating fees for in‐office endoscopies (Current Procedural Terminology [CPT] codes 31231‐31238), in‐office balloon ostial dilation (CPTs 31295‐31298), in‐facility low‐relative value unit (RVU) surgeries (<10 work RVUs [wRVUs]; CPTs 31239‐31288 and 61782), and in‐facility high‐RVU surgeries (>10 wRVUs; CPTs 31290‐31294). Total number of and reimbursements for these services was obtained from yearly National Part B Summary Datafiles. Results Between 2000 and 2021, adjusted reimbursements for low‐ and high‐wRVU rhinologic surgeries decreased by 50.0% and 36.1%, respectively. The average compound annual growth rate (CAGR) decrease was 3.3% and 2.1%, respectively. Excluding a 48.3% unadjusted reimbursement increase between 2000 and 2004, endoscopies saw an adjusted reimbursement decrease of 29.4% from 2004 onward, an average CAGR of −2.1%. From 2011 onward, balloon ostial dilations saw a decrease in adjusted reimbursement of 43.8%, an average CAGR of −6.0%. Nevertheless, after inflation adjustment, National Part B data reveal that Medicare paid more, in total, for these procedures in 2019 than in 2000 due to increasing utilization. Conclusion Medicare reimbursements are complex, adjusted yearly, and undergo constant federal scrutiny due to the increasing costs of health care. These results suggest that, in terms of real dollars, rhinologic procedures have seen a large gradual decrease in Medicare reimbursement, which is important information for policymakers and surgeons alike.

Incidence and Reimbursement Trends for Facial Fracture Repair in the Elderly: A Medicare Analysis

“…This decrease is consistent with other studies on Medicare reimbursement both within the field of otolaryngology 23 and otology 24 as well as at large in fields such as general surgery, 25 neurosurgery, 26 orthopedics, 27 and plastic surgery 28 . Inflation‐adjusted Medicare compensation per rhinologic procedure decreased significantly with an average total percent decrease of 36.09% for high relative value unit (RVU) procedures 29 . In the other specialties, the average nominal dollar reimbursements have increased or decreased by less than 10% 25–28 .…”

“…28 Inflation-adjusted Medicare compensation per rhinologic procedure decreased significantly with an average total percent decrease of 36.09% for high relative value unit (RVU) procedures. 29 In the other specialties, the average nominal dollar reimbursements have increased or decreased by less than 10%. [25][26][27][28] Though reimbursement trends among subspecialties vary greatly, our findings indicate a disproportionate decline in reimbursement for facial fractures, similar to that of rhinologic procedures.…”

Trends in Medicare Reimbursements for Commonly Performed Laryngeal Procedures from 2000 to 2021

“…Inflation-adjusted declines in reimbursement have been found not only in neurosurgery, 4 general surgery, 5 orthopedic surgery, 6 reconstructive plastic surgery, 7 ophthalmology, 21,22 and interventional radiology 23 but also in otolaryngology 9 and its subspecialties. 10,11,24 This study found a 20.3% inflation-adjusted decline in reimbursement of laryngeal procedures. Though our study looked at a greater number of procedures within laryngology, this result is largely in line with the recent findings of Quereshy et al who found an inflation-adjusted decline of 19.4% among head and neck surgical oncology CPT codes 12 and Schartz et al who found an inflationadjusted decline of 21.2% among otology procedures.…”

“…In approximately the last 2 decades, after adjusting for inflation, reimbursements have declined 25.8% in neurosurgery, 4 24.4% in general surgery, 5 29.0% in orthopedic surgery, 6 14.0% in reconstructive plastic surgery, 7 and 29.1% in emergency medicine. 8 Similar, yet further declining, trends have been seen in the field of otolaryngology with inflation-adjusted reimbursements falling 37.6% for the 20 most performed otolaryngology procedures, 9 21.2% for otology procedures, 10 43.1% for rhinology procedures, 11 and 19.4% for head and neck surgical oncology procedures. 12 The objective of this study is to investigate Medicare reimbursement trends for commonly performed laryngeal procedures.…”

Medicare Utilization and Reimbursement Variation Between Rural and Urban Otolaryngologists

“…24,25 The paucity of ORL physicians in rural areas may be at least partially attributable to lower patient volumes and the resulting challenges of financially sustainable practice, especially given recent trends of declining reimbursements in otolaryngology and its subspecialties. 15,[26][27][28] In addition to relative value units (RVUs), geographic practice cost indices, which take into account physician work, practice expense, and malpractice insurance, are used in calculation of a geographic adjustment factor (GAF) that determines the amount a physician is reimbursed. 29 Localities like North and South Dakota have a GAF of around 0.88 while San Francisco, California, has a GAF of around 1.2.…”