Predictors of regional Medicare expenditures for otolaryngology physician services

Smith, Alden; Handorf, Elizabeth; Arjmand, Ellis M.; Lango, Miriam

doi:10.1002/lary.26324

Cited by 6 publications

(8 citation statements)

References 24 publications

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“…1-7 Patient demographics (race/ethnicity, 8 age, 9 sex 9,10 ) may affect costs of care, as can characteristics of provider and hospital separate from clinical volume. 11 A few authors have even examined whether and how cost should influence medical care decisions. 12…”

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confidence: 99%

“…[1][2][3][4][5][6][7] Patient demographics (race/ethnicity, 8 age, 9 sex 9,10 ) may affect costs of care, as can characteristics of provider and hospital separate from clinical volume. 11 A few authors have even examined whether and how cost should influence medical care decisions. 12 The persistent increase in health care cost is systemic, affecting all stakeholders, including patients, care providers, and payers.…”

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confidence: 99%

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Predictors of High Costs of Care among Otolaryngology Patients

Balakrishnan

Moriarty

Rosedahl

et al. 2019

Otolaryngol.--head neck surg.

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Objectives Identify predictors of high-cost otolaryngology care. Study Design Cross-sectional. Setting Tertiary academic multispecialty hospital. Subjects/Methods All patients undergoing ≥1 otolaryngologic procedures from 2011 to 2015. Encounter costs were standardized using previously described methods approximating Medicare reimbursement. Patients were stratified by adult/pediatric and inpatient/outpatient. “Outliers” were defined as total encounter costs ≥95th percentile. Logistic regression measured predictors of outlier status. Results In total, 2433 adult inpatient encounters (95th percentile $57,611), 10,031 adult outpatient encounters ($10,772), 346 pediatric inpatient encounters ($84,639), and 3027 pediatric outpatient encounters ($8978) were included. For adult inpatient and outpatient, isolated head and neck oncologic procedures were the reference group. Among adult inpatients, laryngology and facial plastics procedures predicted higher odds of outlier status (odds ratio [OR] = 4.1 and 7.2). Involvement of multiple otolaryngology subspecialties increased the odds (OR = 4.7). Neck dissection and reconstructive procedures were the most common primary operations for adult inpatient outliers. For adult outpatients, several subspecialties had lower odds than head and neck (OR ≤0.44). Increased comorbidities predicted outliers for adult inpatient care (OR = 1.5); sex, age, race, and ethnicity did not. Cochlear implant was the most common primary operation among adult and pediatric outpatient outliers. Greater subspecialty involvement and increasing age predicted pediatric outpatient outliers (OR = 8.0 and 1.1); younger age and female sex predicted pediatric inpatient outliers (OR = 0.8 and 3.5). Airway procedures dominated pediatric inpatient outliers. Conclusion This is the first large-scale study of high-cost otolaryngology care across multiple subspecialties. Specific procedures and subspecialties and increased comorbidities predicted high-cost care. Contrary to previous studies, patient sex, race, and ethnicity did not.

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Predictors of High Costs of Care among Otolaryngology Patients

Balakrishnan

Moriarty

Rosedahl

et al. 2019

Otolaryngol.--head neck surg.

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“…Joinpoint regression showed that the overall trends in fluticasone claims were mainly driven by Midwestern states and some Southern states (Figure 2; Supplemental Table 3). In a study by Smith et al 27 Medicare costs for otolaryngology physician services showed wide geographical variations, and these discrepancies were strongly associated with the availability of otolaryngologists. It is likely that the regional patterns in our study are also partially due to the varying availability of health services.…”

Section: Discussionmentioning

confidence: 99%

Trends in Nasal Spray Prescribing Patterns by Otolaryngologists in the US Medicare Population

Kim

Tran

Kim

et al. 2021

Ann Otol Rhinol Laryngol

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Objectives: To quantify national and state-level prescribing and cost trends for the 3 most prescribed nasal sprays by otolaryngologists in the Medicare population. Methods: Through the Centers for Medicare and Medicaid Services (CMS) database and the Kaiser Family Foundation, we retrieved data on Medicare enrollment and on claims and costs of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists from January 1, 2013 to December 31, 2017. Results: From 2013 to 2017, CMS reimbursed $128.8 million for 5.2 million claims of fluticasone propionate, azelastine HCl, and ipratropium bromide prescribed by otolaryngologists. The national claim rate for fluticasone propionate increased 6.5% per year from 2013 to 2015 and then decreased 4.3% per year from 2015 to 2017 while azelastine HCl and ipratropium bromide consistently increased annually (19.0% and 12.2% respectively) from 2013 to 2017. The cost for fluticasone propionate decreased 33.0% a year from 2013 to 2015 and then increased 5.4% annually to $13.60 per claim in 2017. Azelastine HCl decreased 14.8% annually from $91.30 to $50.23 per claim and ipratropium bromide increased 5.2% annually to $34.78 in 2017. Variations in the claim rate and cost for all 3 nasal sprays were observed in some states. Conclusions: Otolaryngologists are prescribing azelastine HCl and ipratropium at an increasingly higher rate in the Medicare population, while the rate for fluticasone propionate has been decreasing nationally. Utilization and costs of nasal sprays also vary geographically across the United States.

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“…In a similar vein, regional Medicare expenditures for otolaryngology services vary widely and are strongly correlated with provider and hospital factors rather than clinical volume or population factors. 21,22 As a result, we chose a different method to approximate regional demand.…”

Section: Discussionmentioning

confidence: 99%

Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits

Hur

Gibbons

Finch

2020

Otolaryngol.--head neck surg.

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Objective To analyze the spatial variation of sociodemographic factors associated with the geographic distribution of new patient visits to otolaryngologists. Study Design Retrospective cross-sectional analysis. Setting United States. Subject and Methods Medicare new patient visits pooled from 2012 to 2016 to otolaryngology providers were obtained from the Centers for Medicare and Medicaid Services, and county-level sociodemographic data were obtained from the 2012-2016 American Community Survey. The mean number of new patient visits per otolaryngology provider by county was calculated. The spatial variation was analyzed with negative binomial and geographically weighted regression. Predictors included various neighborhood characteristics. Results There were 7,199,129 Medicare new patient visits to otolaryngology providers from 2012 to 2016. A 41.7-fold difference in new patient evaluation rates was observed across US counties (range, 11-458.8 per otolaryngology provider). On multivariable regression analysis, median age, sex, work commute time, percentage insured, and the advantage index of a county were predictors for the rate of new patient visits to otolaryngology providers. However, geographically weighted regression demonstrated that the association of a county’s disadvantage index, advantage index, percentage insured, and work commute times with new patient visits per provider varied across space. Conclusions There are wide geographic differences in the number of new Medicare patients seen by otolaryngologists, and the influence of county sociodemographic factors varied regionally. Further research to analyze the variations in practice patterns of otolaryngologists is warranted to predict future public health needs.

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Predictors of regional Medicare expenditures for otolaryngology physician services

Abstract: NA. Laryngoscope, 127:1312-1317, 2017.

Cited by 6 publications

References 24 publications

Predictors of High Costs of Care among Otolaryngology Patients

Predictors of High Costs of Care among Otolaryngology Patients

Trends in Nasal Spray Prescribing Patterns by Otolaryngologists in the US Medicare Population

Geographic Heterogeneity in Otolaryngology Medicare New Patient Visits

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