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

Abstract

Background The use of balloon catheter dilation (BCD) to treat chronic rhinosinusitis has increased dramatically since its conception, necessitating further characterization of BCD providers and trends in its usage. Medicare data on BCD providers have made it possible to study recent demographic patterns. There has also been an increase in mid-level providers’ scope of otolaryngologic practice that is not well defined. Objective To better understand BCD adoption by studying volume of BCD procedures as well as training, geography, and practice socioeconomic characteristics of BCD providers for Medicare beneficiaries. Methods We reviewed Medicare Provider Utilization and Payment Data Public Use Files for 2014 and 2015 for providers with claims for BCD of the sinuses. We extracted provider zip code, state, gender, and number of services per BCD code. We obtained median household income by zip code and geographic region based on US Census Bureau data. Providers were classified using an Internet search to determine practice setting and type of specialty training/certification. Results In 2014 and 2015, 428 providers performed 42 494 BCDs billed to Medicare beneficiaries. Among BCD providers, 5.1% were female, 98.1% had Doctor of Medicine/Doctor of Osteopathic Medicine credentials, and 1.9% had nurse practitioner/physician assistant credentials. Over the 2-year period, the median number of BCDs was 63 for physicians and 37 for mid-level providers. Fellowship-trained rhinologists performed a median of 38 BCDs over 2 years. The most common subspecialty certification/training was in facial plastics and reconstructive surgery. The majority of providers (63.8%) performed 1 to 99 BCDs over the 2 years. In the South, there were 21.9 BCD procedures performed per 100 000 people compared to 7.3 in the Northeast, 9.3 in the Midwest, and 8.5 in the West. Conclusion There is a large range in total BCD procedures performed by individual providers, and this varies by certain provider characteristics. Mid-level providers have emerged as a significant population performing BCD.

Advanced Practice Providers Utilization Trends in Otolaryngology From 2012 to 2017 in the Medicare Population

“…Physician assistants (PAs) and nurse practitioners (NPs) form a growing advanced practice provider (APP) group and are playing an increasing role in otolaryngology (ENT) practices. 1,2 Many ENT services are provided independently by APPs. Prior to coronavirus disease 2019 emergency responses, NPs practiced with full independence in 22 states and the District of Columbia, while PAs practiced under the supervision of a physician.…”

Otolaryngologist Characteristics and Outlier Use of Balloon Sinuplasty in the Medicare Population

“…Using CMS claims data from 2014 and 2015, Munteau et al demonstrated wide differences in BSP performance among otolaryngology subspecialties. 22 Notably, rhinologists and pediatric otolaryngologists recorded the lowest mean number of BSP procedures, whereas facial plastic and general otolaryngologists recorded the highest. 22 In this investigation, we demonstrate that outlier otolaryngologists comprised less than 5% of the study cohort but accounted for greater than 44% of all balloon procedures in the Medicare population.…”

“…22 Notably, rhinologists and pediatric otolaryngologists recorded the lowest mean number of BSP procedures, whereas facial plastic and general otolaryngologists recorded the highest. 22 In this investigation, we demonstrate that outlier otolaryngologists comprised less than 5% of the study cohort but accounted for greater than 44% of all balloon procedures in the Medicare population. We also identify characteristics unique to the group of outlier otolaryngologists.…”

“…Consequently, the recent explosion in both utilization and expenditure of balloon procedures may signify unnecessary cost burden and inappropriate use in some patients. Using CMS claims data from 2014 and 2015, Munteau et al demonstrated wide differences in BSP performance among otolaryngology subspecialties 22 . Notably, rhinologists and pediatric otolaryngologists recorded the lowest mean number of BSP procedures, whereas facial plastic and general otolaryngologists recorded the highest 22 .…”

Staying Safe, Caring for Each Other, and Moving the Needle—Together

“…On the more controversial side of the rhinologic world, a Medicare database analysis by Munteanu et al 2 aimed to better characterize providers performing balloon catheter dilation (BCD) and trends in the usage of balloons for CRS treatment. Expectedly, the authors found that there was a large range in total BCD procedures performed by individual providers (which varied based on several provider characteristics), but quite unexpectedly, they also uncovered that mid-level providers have emerged as a significant population performing these procedures.…”