Utilization and reimbursements for sinus procedures: A five‐year analysis

Abstract

Objectives/Hypothesis Balloon sinuplasty has become an increasingly popular option for patients undergoing surgical treatment of sinusitis. This study analyzes utilization and growth of these procedures across a large cohort of patients over a 5‐year period. Study Design Retrospective data review. Methods This was a retrospective review of Medicare utilization and billing data. Utilization and payment values were obtained from Medicare claims data using Centers for Medicare and Medicaid Services datasets. All Medicare claims were analyzed from 2012 to 2016. Data were extracted for balloon sinuplasty and endoscopic sinus surgery claims. Procedure location, total submitted claims, charges, and payments were compared. Results From 2012 to 2016, the number of balloon procedures increased from 5,603 to 25,640. Traditional endoscopic sinus surgery procedures increased from 15,509 to 18,164. Aggregate Medicare payments to otolaryngologists for endoscopic sinus surgery have remained relatively stable, whereas there has been a 450% increase in total payments to providers of balloon sinuplasty. In 2016, total payments to providers of balloon procedures ($40.5 million) were substantially higher than payments to providers of non–balloon‐based endoscopic sinus surgery ($4.7 million). The number of providers performing balloon procedures has increased 277% versus 17% for traditional sinus surgery. Conclusions There has been a rapid expansion in the number of sinus procedures in the Medicare population from 2012 to 2016. Office‐based balloon procedures account for the overwhelming majority of the increases in procedures and payments. Per procedure and aggregate payments are now higher for sinuplasty procedures than for traditional sinus surgery. Level of Evidence NA Laryngoscope, 129:2224–2229, 2019

Analysis of Sinus Balloon Catheter Dilation Providers Based on Medicare Provider Utilization and Payment Data

“…Although the most common sinus procedure performed by general and facial plastics ENTs is thought to be ESS, 2 this may change, as BCD overtook ESS as the most common sinus procedure for Medicare patients in 2015. 26 Several other provider characteristics were associated with higher BCD volumes in our study. The majority of BCDs were performed in higher income zip codes.…”

“…Although the most common sinus procedure performed by general and facial plastics ENTs is thought to be ESS, 2 this may change, as BCD overtook ESS as the most common sinus procedure for Medicare patients in 2015. 26…”

Financial Transactions from Manufacturers to Otolaryngologists in 2018

“…Balloon sinuplasty is a growing field within otolaryngology, due to the accessibility, ease of use in the office setting, and higher reimbursement rates. It also exhibits equivalent outcomes to that of traditional FESS in limited maxillary and frontal sinus disease 3,12,13 . Similarly, drug eluting stents are the third most popular product associated with payments.…”

Review and Analysis of Research Trends in Surgical Treatment of Pediatric Chronic Sinusitis

“…18 In addition, there are ethical considerations when conducting studies that transpose a procedure which has gained popularity in adults to children without a distinct advantage established in the pediatric population. 19 Pediatric patients are less likely to tolerate balloon sinuplasty as an in-office procedure, removing one of its major advantages in adults, and many otolaryngologists may not feel it is beneficial from a cost benefit perspective to pursue research on the topic. 10 Another potential reason could relate to the time needed to develop a suitable patient cohort to conduct research with and the time needed to publish subsequent literature.…”