(426) Reimbursement to Charge Ratios for Medicare Part B Otolaryngology Procedures

Introduction: Examining and understanding Medicare reimbursement trends are necessary for promoting acceptable and fair compensation models in otolaryngology. This study aimed to evaluate recent changes in utilization, reimbursement and charges for otolaryngology surgical procedures billed to Medicare.

Methods: We queried the 2010-2019 Physician/Supplier and Procedure Summary from the Centers for Medicare and Medicaid Services to collect billing information, including service counts, charges, and reimbursements, of all procedures billed to Medicare Part B by otolaryngologists. Monetary values were adjusted to the 2019 US dollars. We calculated weighted mean reimbursements and charges, whose ratios were calculated as reimbursement-to-charge ratios (RCRs). We calculated total changes and r2 values to assess trends over time for procedures as well as stratified by organ system.

Results: From 2010 to 2019, the overall enrollment-adjusted utilization for 3919 otolaryngologic procedures decreased by 16.1% (r2 = 0.95). Utilization increased in certain organ-specific procedural groupings such as procedures of the accessory sinuses (+21.2%, r2 = 0.85) and the inner ear (+300%, r2 = 0.80). Charges increased by 3.9% (r2= 0.61), reimbursement decreased by 9.3% (r2 = 0.85) and RCR decreased by 12.8% (r2 = 0.91). Reimbursement-to-charge ratios decreased for all procedural groupings during this time period. The procedural groupings most affected by the decrease in RCR were procedures of the inner ear, external ear and trachea/bronchi which saw a decrease in RCR values of 41.5% (r2 =0.14), 28.4% (r2 = 0.93) and 25.4% (r2 = 0.92) respectively.

Conclusions: Over the past decade, Medicare utilization and reimbursement for otolaryngologic surgical procedures decreased whereas charges increased. As a result, the RCR for all billed otolaryngologic procedural expenses has steadily decreased from 2010 to 2019. Moving forward, increased understanding and reaction to these trends will be critical for Medicare recipients, policymakers and providers in order to ensure available and affordable access to quality otolaryngology care.