Compensation Rates for Otolaryngologic Procedures Under the Medicare Physician Fee Schedule in 2018

Kondamuri, Neil; Miller, Ashley L.; Rathi, Vinay K.

doi:10.1002/lary.29328

Cited by 2 publications

(11 citation statements)

References 13 publications

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“…While these studies examine important questions on reimbursement for otolaryngologic procedures, there lacks an analysis of reimbursement trends for the most common head and neck surgical oncologic codes. A cross‐sectional analysis of 2018 CMS data by Kondamuri et al suggest that ablative head and neck surgical codes are among the middle of the pack for inpatient payment rates and the lowest ambulatory payment rate, when compared to other otolaryngologic subspecialties 8 . An investigation exploring reimbursement trends to these procedure codes will add to the increasing insight into the unique incentives surrounding the provision of cancer care in otolaryngology and could springboard important discussions on reimbursement reform within the subspecialty.…”

Section: Introductionmentioning

confidence: 99%

“…A cross-sectional analysis of 2018 CMS data by Kondamuri et al suggest that ablative head and neck surgical codes are among the middle of the pack for inpatient payment rates and the lowest ambulatory payment rate, when compared to other otolaryngologic subspecialties. 8 An investigation exploring reimbursement trends to these procedure codes will add to the increasing insight into the unique incentives surrounding the provision of cancer care in otolaryngology and could springboard important discussions on reimbursement reform within the subspecialty. In this study, we aimed to compare temporal trends in CMS reimbursement for the most commonly billed surgical procedures within head and neck surgical oncology from 2000 to 2020.…”

Section: Introductionmentioning

confidence: 99%

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Medicare reimbursement trends from 2000 to 2020 in head and neck surgical oncology

et al. 2022

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Background Considering limited data exploring reimbursement trends at the subspecialty level within head and neck surgical oncology, we sought to characterize these trends for head and neck‐specific codes from 2000 to 2020. Methods Using the Centers for Medicare and Medicaid Services' Physician Fee Schedule Look‐Up Tool, reimbursement data, adjusted to 2020 U.S. dollars, for 37 head and neck surgical oncologic procedure codes were collected from 2000 to 2020. Results From 2000 to 2020, despite gross reimbursement for all head and neck procedures increasing by 23.2%, when adjusted for inflation, physician reimbursement decreased by 19.4%. Only 4 of 37 examined codes increased in net reimbursement over the study period. Conclusion Medicare reimbursement for the most common head and neck oncologic procedure codes decreased from 2000 to 2020. Further research is necessary to explore the implications of these trends on the delivery of patient care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medicare reimbursement trends from 2000 to 2020 in head and neck surgical oncology

et al. 2022

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“…Our primary outcome measures were (1) total compensation rate and (2) intraservice (i.e., incision to closure) compensation rate for each studied procedure. We used the building block method 8,10,13,14 to calculate these rates. This well‐established method allocates physician work into four discrete blocks: (1) pre‐service work (including preoperative evaluation, patient preparation, surgical scrub time, and surgical positioning); (2) intraservice work (from surgical incision to closure); (3) immediate post‐service work (recovery in post‐anesthesia care unit); and (4) global period work (including inpatient care and postoperative visits included within the procedure‐defined global period).…”

Section: Methodsmentioning

confidence: 99%

“…We additionally calculated intraservice (“skin‐to‐skin”) intensity and compensation rates using previously established methods 8,10,13,14 . We calculated intraservice RVUs by subtracting all pre‐service, immediate post‐service, and global period RVUs from the total RVUs for each procedure.…”

Section: Methodsmentioning

confidence: 99%

“…These estimates have resulted in relatively low valuations for procedures in otolaryngology as compared to other surgical fields 8 . Within otolaryngology, there is substantial variation in intensity estimates for procedures commonly performed in adult populations 10 . In this study, we sought to investigate current CMS estimates of intensity for the range of surgical procedures performed by pediatric otolaryngologists.…”

Section: Introductionmentioning

confidence: 99%

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Compensation Rates for Pediatric Otolaryngology Procedures Under the Medicare Physician Fee Schedule in 2021

2022

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Introduction The Medicare Physician Fee Schedule (PFS) is the basis for physician reimbursement by public and private payers. The PFS values physician services according to the estimated time and intensity required to perform them; intensity reflects the summation of technical skill, cognitive load, and risk‐related stress. The fee schedule uses relative value units (RVUs) as a metric that permits comparison across procedures. Recent debate has focused on whether the methods by which the Centers for Medicare & Medicaid Services (CMS) estimate procedural intensity are valid. We therefore sought to investigate current CMS estimates of intensity (RVUs/min) for surgical procedures performed by pediatric otolaryngologists. Methods We performed a retrospective, cross‐sectional analysis of fiscal year 2021 PFS valuations for pediatric otolaryngology key indicator procedures specified by the Accreditation Council for Graduate Medical Education. We additionally examined general otolaryngology procedures, including adenotonsillectomy and tympanostomy tube insertion. We utilized the 2021 Medicare PFS conversion factor of $34.89/RVU to convert intensity (wRVUs/min) to a compensation rate ($/min). Primary outcomes were: (1) total compensation rate and (2) intraservice (i.e., incision‐to‐closure) compensation rate for each studied procedure. Results Our study sample included 167 unique procedures. The mean (standard deviation) total compensation rate for all included procedures was $1.35/min ($0.29/min) and the mean intraservice rate was $1.71/min ($0.89/min). Intraservice compensation rates ranged from $‐1.50/min (drainage of throat abscess) to $4.75/min (pediatric tracheostomy). Discussion Total and intraservice compensation rates under the Medicare PFS vary widely for surgical procedures performed by pediatric otolaryngologists. Further investigation is necessary to examine the validity of assumptions underlying these procedural intensity valuations. Level of Evidence NA Laryngoscope, 133:1739–1744, 2023

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Compensation Rates for Otolaryngologic Procedures Under the Medicare Physician Fee Schedule in 2018

Cited by 2 publications

References 13 publications

Medicare reimbursement trends from 2000 to 2020 in head and neck surgical oncology

Medicare reimbursement trends from 2000 to 2020 in head and neck surgical oncology

Compensation Rates for Pediatric Otolaryngology Procedures Under the Medicare Physician Fee Schedule in 2021

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