What does Medicare pay rhinologists? An analysis of Medicare payment data

Clair, Brandon; Goyal, Parul

doi:10.1002/alr.21461

Cited by 6 publications

(6 citation statements)

References 3 publications

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“…Table 3 highlights charge and payment statistics for otology providers. Again, overall data for otolaryngology providers (n = 8,318) had been obtained from a prior study 2 and were used for comparisons. The mean submitted charge was $204,851 per otology provider compared to a mean of $211,209 for all otolaryngologists (p = 0.92).…”

Section: Resultsmentioning

confidence: 99%

“…Data for all other otolaryngology providers (n = 8,318) had been obtained from previously published material. 2 Otology providers were selected from the complete roster of the American Otological Society (AOS). In total, 147 unique, active otology providers were included for analysis.…”

Section: Methodsmentioning

confidence: 99%

“…1 There has been a recent subspecialty analysis of rhinologists, providing an indepth comparison to general otolaryngologists. 2 The goal of the present study was to similarly understand variations that exist within the subspecialty of otology. By understanding the variations in the payment data, subspecialists may make meaningful comparisons of their practice with colleagues and may investigate factors contributing to these variations.…”

Section: Introductionmentioning

confidence: 99%

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Analyzing Medicare Payments to Otologists

2018

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The study objective was to analyze Medicare payment data to otologists compared to otolaryngologists, using the publicly released Centers for Medicare and Medic-aid Services dataset. Charges, payments, and common Current Procedural Terminology codes were obtained. Otology providers were selected from the roster of the American Otological Society. Descriptive statistics and unequal variance two-tailed t tests were used for comparisons between otologists (n = 147) and otolaryngologists (n = 8,318). The mean overall submitted charge was $204,851 per otology provider and was $211,209 per other otolaryngology providers (non-otologists) (p = 0.92). The mean payment to otologists was $56,191 (range: $297 to $555,274, standard deviation [SD] ±$68,540) and significantly lower (p = 0.005) than $77,275 to otolaryngologists (range: $94 to $2,123,900, SD ±$86,423). The mean submitted charge-to-payment ratio (fee multiplier) per otology provider was 3.87 (range 1.50 to 9.10, SD ±1.70), which was significantly higher (p < 0.0001) than the ratio for otolaryngologists (mean 2.91; range: 1.25 to 17.51, SD ±1.22). Office visit evaluation and management (E&M) codes made up the majority in terms of use and payments. Interestingly, allergy-based services comprised a substantial amount of repeat use among a small subset of otologists. Audiology services were billed by a similar percentage of otologists and other otolaryngologists (52%), but otologists received a significantly higher overall payment for these services.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Analyzing Medicare Payments to Otologists

2018

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“…Since then, additional years of data have been released by CMS. Multiple studies have used these data to describe specific practice patterns across the specialty and within subspecialties . This study analyzes utilization and growth of sinus and nasal procedures across a large cohort of patients over a 5‐year period.…”

Section: Introductionmentioning

confidence: 99%

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

Koester

Goyal

2019

The Laryngoscope

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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

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“…However, based upon a direct healthcare cost reduction basis alone, the surgical costs would appear not to be justified. Clair and Goyal used the Centers for Medicare and Medicaid Services (CMS) data set to evaluate Medicare payments to rhinologists. Academic rhinologists submitted fewer claims than their private practice colleagues, but overall charges and payments were comparable.…”

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confidence: 99%

Editorial

Kennedy¹

2015

Int Forum Allergy Rhinol

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Patient compliance is the largest "elephant in the room" in the management of chronic diseases and chronic rhinosinusitis (CRS), and an area clearly worthy of further research and innovative solutions. Although studies have not yet been performed within our subspecialty, studies performed in other chronic diseases have demonstrated that this is a major barrier in terms of the management of chronic disease states. In one study evaluating the use of preventive medications following a myocardial infarction, rates of adherence for medical therapy ranged between 35.9% and 49%. Usage rates remained low and were only slightly higher when the medication was provided at no cost.1 In another study, performed in Québec, where there is a strong social program to reduce or eliminate prescription co-pays, over 30% of prescriptions were never filled (primary nonadherence) in a primary care setting. The level of primary nonadherence in this study rose from 30% to nearly 40% within the category of "rhinitis" management.2 One would hope that the rate of primary nonadherence would be lower within a specialty setting, but how many of our patients actually use the medications that we prescribe on an ongoing regular basis? Based upon the information from other chronic diseases, I have no doubt that it is much lower than we anticipate. In this edition of IFAR, Cingi et al.3 evaluate the impact of a mobile patient engagement application for asthma patients. This important study showed a significant improvement in the Rhinitis Quality-Of-Life Questionnaire (RQLQ) at 1 month, and, in the asthma patients, the Asthma Control Test (ACT) at the end of the study (3 months) in the intervention groups as opposed to the control groups. One of the early studies on my patient population showed that if we could completely resolve the persistent and typically asymptomatic inflammation that persists following surgery for CRS, no patients required revision surgical intervention over the nearly 8-year mean follow-up period. 4 The question therefore arises as to how much we could improve our surgical results, or perhaps even decrease the need for surgical intervention, with active and ongoing patient education and intervention, and how we could make this intervention cost effective.

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What does Medicare pay rhinologists? An analysis of Medicare payment data

Cited by 6 publications

References 3 publications

Analyzing Medicare Payments to Otologists

Analyzing Medicare Payments to Otologists

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

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