Understanding the Composition of a Comprehensive Otolaryngologist's Practice Through Medicare Reimbursements

Abstract

ObjectiveWith a rising number of otolaryngology (ORL) graduates completing a fellowship, the number of generalists (also known as comprehensive ORLs [c‐ORLs]), arguably the group of ORLs most needed, is likely to decrease. However, the practice and reimbursement patterns of c‐ORLs have yet to be examined.Study DesignCross‐sectional retrospective analysis.Setting2019 Medicare Provider Utilization and Payment Datasets.MethodsAll ORLs were isolated (n = 8959), and then a random 10% sample was obtained. These 897 ORLs were queried for fellowship completion, isolating out those who have not completed a fellowship, and characterizing their practice patterns with regards to Medicare, the largest insurer in the US.ResultsWithin the random sample, 554 (61.8%) were c‐ORLs, of which 47 (8.5%) practiced in an academic setting. c‐ORLs billed a mean of 52.9 (SD: 26.6) Current Procedural Terminology (CPT), and community‐based c‐ORLs had a more diverse practice (P < .001). On average, Medicare paid $138,942 ($117,563) to each c‐ORL for 1982.2 (2614.7) services for 451.7 (296.9) patients. Ninety‐five percent of their total reimbursements were office‐based. Of 250 unique CPT codes billed, 52.8% of all c‐ORLs reimbursements were from evaluation and management services, 17.8% from rhinology, 9.7% from otology/neurotology, and 9% from laryngology.ConclusionThough surgery is an integral aspect of all ORLs' training and practice, c‐ORLs practice in a largely office‐based setting, at least with regard to Medicare patients. While c‐ORLs clearly practice with a diverse skill set, their reimbursement patterns suggest rhinology makes up the largest proportion of their procedural practice.