Medicare volume and reimbursement trends in lingual and hyoid procedures for obstructive sleep apnea

Torabi, Sina J.; Tsang, Cynthia; Patel, Rahul A.; Nguyen, Theodore V.; Manes, R. Peter; Kuan, Edward C.; Trask, Douglas K.

doi:10.1016/j.amjoto.2024.104361

American Journal of Otolaryngology

2024

DOI: 10.1016/j.amjoto.2024.104361

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Medicare volume and reimbursement trends in lingual and hyoid procedures for obstructive sleep apnea

Sina J. Torabi,

Cynthia Tsang,

Rahul A. Patel

et al.

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2024

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Cited by 2 publications

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Trends in Medicare Utilization and Reimbursement of Tracheostomy From 2000 to 2022

Patel,

Torabi,

Izreig

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo analyze the utilization and reimbursement for tracheostomy.Study DesignRetrospective Cross‐Sectional Study.SettingCenters for Medicare & Medicaid Services (CMS) Medicare Provider Utilization and Payment Data (2013 and 2021) and Part B Medicare Fee‐For‐Service National Summary Data (2000‐2022).MethodsUtilization, payment, and specialty breakdown were analyzed for planned tracheostomy (Current Procedural Terminology [CPT] codes 31600, 31601, 31610) and emergency tracheostomy (CPT codes 31603, 31605).ResultsFrom 2000 to 2022, there was a 48.9% decrease (40,754‐20,812) in number of planned tracheostomies and a 75.3% decrease (3277‐811) in number of emergency tracheostomies, leading to an overall decrease of 51%. Similarly, there was a 59.3% inflation‐adjusted decrease ($13.4‐$5.5 million) in total reimbursement for planned tracheostomies and an 82.1% inflation‐adjusted decrease ($1.1 million‐$205 thousand) in total reimbursement for emergency tracheostomies. There was a 20.3% inflation‐adjusted decrease ($329‐$262) in reimbursement per planned tracheostomy and a 27.7% inflation‐adjusted decrease ($349‐$252) in reimbursement per emergency tracheostomy. In our sample of 280 high‐volume tracheostomy providers in 2021 (28.2% otolaryngology, 28.2% general surgery, 14.6% thoracic surgery, 14.3% pulmonary disease, 6.4% critical care), the average provider performed 15.8 tracheostomies and was reimbursed $5362.ConclusionDespite significant declines in tracheostomy utilization and reimbursement, understanding trends for these lifesaving procedures are critical for otolaryngologists and other providers in delivering high‐quality care, and can be used by surgeons, hospital systems, and policymakers to guide future health care legislation.

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Trends in Medicare Utilization and Reimbursement of Tracheostomy From 2000 to 2022

Patel,

Torabi,

Izreig

et al. 2024

Otolaryngol.--head neck surg.

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Trends in Soft Palate Surgery and Reimbursements for Obstructive Sleep Apnea Among the Medicare Population

Torabi,

Frank,

Patel

et al. 2024

Ann Otol Rhinol Laryngol

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Objectives: This study aims to analyze trends in utilization and reimbursement of soft palate surgery for OSA using the Medicare national database. Methods: A retrospective analysis of the 2000 to 2021 Part B National Summery datafiles using current Procedural Terminology (CPT) codes 42145 (uvulopalatopharyngoplasty [UPPP]), 42950 (pharyngoplasty [PP]), and 42140 (uvulectomy [UVU]) was performed. Results: Between 2000 and 2021, the number of OSA surgeries fell 65.7% from 4208 to 1443. UPPP fell 87.6% from 3455 in 2000 to 428 in 2021 ( P < .001). UVU also fell in popularity, from 568 to 376 (33.8%; P < .001). In contrast, the performance of PP rose 245.4% over time, from 185 to 639 ( P < .001). When comparing 2000 to 2009, both PP and UVU rose in relative use (from 4.4% to 12.3% and from 13.5% to 20.4% of all soft palate OSA surgeries, respectively), while UPPP fell (82.1% to 67.3%; P < .001). Total Medicare payments for all 3 procedures fell 57.2% from $1 658 844 to $633 091 ( P < .001). Adjusted total UPPP payments fell 88.7% ( P < .001). Adjusted total PP payment rose 137.5% to $262 538 in 2021 ( P < .001). Conclusion: Soft palate surgery for OSA has declined amongst the Medicare population over 21 years (2000-2021). The more individualized and tissue sparing PP has risen in popularity but did not overcome the large decline of the traditional UPPP. Accordingly, there was a 75.7% fall in inflation-adjusted reimbursements. Overall, our data indicates a decline in soft palate surgery in the management of geriatric OSA, with modest relative increase in pharyngoplasty procedures.

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Medicare volume and reimbursement trends in lingual and hyoid procedures for obstructive sleep apnea

Cited by 2 publications

References 53 publications

Trends in Medicare Utilization and Reimbursement of Tracheostomy From 2000 to 2022

Trends in Medicare Utilization and Reimbursement of Tracheostomy From 2000 to 2022

Trends in Soft Palate Surgery and Reimbursements for Obstructive Sleep Apnea Among the Medicare Population

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