(081) Changes in Geographic Medicare Reimbursement for Otolaryngology Procedures from 2013-2022

Introduction: Analyzing geographic changes in Medicare reimbursement for otolaryngology procedures has not been performed to discover regions where otolaryngologists are most impacted. We analyzed Medicare reimbursement changes from 2013 to 2022 for all U.S. states and territories, exploring their relationship with select social determinants of health (SDOH).

Methods: The top 20 Current Procedural Terminology codes for otolaryngology procedures were analyzed from the American Academy of Otolaryngology-Head and Neck Surgery’s database. Medicare Administrative Contractor codes were used to identify states using the Centers for Medicare and Medicaid Services’ Physician Fee Schedule. Each price was adjusted for inflation using the consumer price index and weighted using an index of codes. A total percent change was generated for each state or territory. State-based data for various SDOH were used to calculate a correlation coefficient with geographic changes in reimbursement (statistical significance factored with α of 0.05).

Results: From 2013 to 2022, the total change in Medicare reimbursement for Puerto Rico (-12.5%), Washington (-22.5%), and Alabama (-25.4%) were the least impacted. Illinois (-33.2%), Kansas (-30.5%), and Wisconsin (-30.5%) were the most impacted. The mean and median for all states and territories were -28.0 % and -28.5%, respectively. There was no statistically significant correlation between Medicare reimbursement changes and physicians per capita (r = +0.26, p = 0.07), cost of living (+0.27, 0.06), homelessness (+0.17, 0.23), population density (+0.06, 0.67), population age more than 60 (0.00, 0.99), and medicare enrollment (0.00, 1.00).

Conclusions: Medicare reimbursement changes for otolaryngology procedures suggested disparities between states, and none of the SDOH showed a statistically significant correlation with these changes. Overall, these SDOH do not appear to contribute to changes in geographic Medicare reimbursement. This study emphasizes a need to understand the effects of state-by-state differences in reimbursement and to consider SDOH for future policy change.