1
|
Pudrith C, Chen X, Buac M, Billingsly D, Hill E. Demographic Disparities in Drive Times to the Nearest Audiologist in the United States. Am J Audiol 2024; 33:768-781. [PMID: 38758682 DOI: 10.1044/2024_aja-23-00279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
PURPOSE Audiological services are underused, possibly because patients need to drive long distances to see a provider. In this study, we measured the association of drive times to the nearest audiologist with population density, income, ethnicity, race, and distance to the nearest audiology graduate program. METHOD Drive times for each census block group to the nearest audiologist were measured using census data, the National Provider Identifier Registry, and a geographic analyzing tool called ArcGIS for all block groups within the United States. The association between drive times and population density, income, ethnicity, race, and audiology program distance was evaluated with a population density-matched case-control study and multiple linear regression analyses. RESULTS Approximately 5.29 million Americans need to drive at least 1 hr to visit their closest audiologist. The 10% most rural-dwelling Americans drive an average of 33.8 min. The population density-matched case-control study demonstrated that percent below poverty, percent identifying as Hispanic, and travel times to the nearest audiology program were all significantly higher in census block groups with high drive times to the nearest audiologist. An average of 7.96% of individuals in census block groups with low drive times identified as Hispanic, but 18.8% identified as Hispanic in high drive time groups. The multiple linear regression showed that the effect of demographics and distance to the nearest audiology program was highest in rural areas. In both analyses, adjusting for poverty did not drastically change the effect of percent identifying as Hispanic on drive times. CONCLUSIONS Long drive times restrict access to audiological care for those who live in rural areas. This restriction disproportionately affects those in rural areas who identify as Hispanic or have low income.
Collapse
Affiliation(s)
- Charles Pudrith
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb
| | - Xuwei Chen
- Department of Earth, Atmosphere and Environment, Northern Illinois University, DeKalb
| | - Milijana Buac
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb
| | - Danica Billingsly
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb
| | - Elizabeth Hill
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb
| |
Collapse
|
2
|
Fattahi CB, Zaro C, Chung JJ, Lewis RF, Chari DA. Comparative utility of vestibular function tests in patients with peripheral and central vestibular dysfunction. J Otol 2024; 19:5-9. [PMID: 38313756 PMCID: PMC10837540 DOI: 10.1016/j.joto.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/31/2023] [Indexed: 02/06/2024] Open
Abstract
Background Bithermal caloric irrigation, video head impulse test (vHIT), and rotational testing are commonly used to assess peripheral vestibular function, but the relative clinical utility of each test in differentiating patients with peripheral vestibulopathy is debated. Objectives To determine whether (1) the combination of two or more vestibular tests enhances diagnostic utility over a single test; (2) abnormal test results on vestibular tests correlate with one another. Methods Retrospective analysis of data collected from multidisciplinary vestibular clinics at two academic medical centers from 2016 to 2022. Results 150 patients (54.10 ± 15.09 years, 88 females) were included. No individual test was significantly better at predicting the presence of peripheral vestibular damage (p > 0.05). vHIT test results improved significantly when combined with either the caloric test (p = 0.007) or rotary chair test (p = 0.039). Caloric and rotational testing had high sensitivity (74.65% and 76.06%, respectively) and specificity (83.54% and 78.48%, respectively). vHIT demonstrated excellent specificity (89.87%) but poor sensitivity (47.89%). Caloric, vHIT, and rotary chair tests results did not correlate with one another (p > 0.05). Conclusions Vestibular function tests have comparable diagnostic utility, yet each offers unique advantages. Caloric and rotational testing may be best suited for screening peripheral damage and vHIT may function ideally as a confirmatory test.
Collapse
Affiliation(s)
- Cameron B. Fattahi
- Department of Otolaryngology – Head and Neck Surgery, UMASS Memorial Medical Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
| | - Christopher Zaro
- Department of Otolaryngology – Head and Neck Surgery, UMASS Memorial Medical Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Janice J. Chung
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Richard F. Lewis
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Divya A. Chari
- Department of Otolaryngology – Head and Neck Surgery, UMASS Memorial Medical Center, University of Massachusetts Chan Medical School, Worcester, MA, USA
- Jenks Vestibular Physiology Laboratory, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Otolaryngology – Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Chieffe DJ, Zuniga SA, Marmor S, Adams ME. Nationwide Utilization of Computerized Dynamic Posturography in an Era of Deimplementation. Otolaryngol Head Neck Surg 2023; 169:1090-1093. [PMID: 36994931 PMCID: PMC10782839 DOI: 10.1002/ohn.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/31/2023]
Abstract
Computerized dynamic posturography (CDP) provides multisensory assessment of balance. Consensus is lacking regarding CDP utility and coverage determinations vary. To inform best practices and policy, this cross-sectional study quantifies provider use of CDP among Medicare beneficiaries over time (2012-2017), by geographic region (hospital referral region [HRR]), and specialty. We observed 195,267 beneficiaries underwent 212,847 CDP tests totaling $15,780,001 in payments. Number of CDPs billed per 100,000 beneficiaries varied 534-fold across HRRs. Over 6 years, CDP use grew by 84% despite stagnant reimbursement. More utilization was attributable to primary care clinicians than specialties focused on care for dizziness and balance disorders. The observed growth and variation illustrate the potential for policy and provider preferences to drive unexpected practice patterns and underscore the need to engage a broad network of providers to develop optimal guidelines for use. CDP may offer a use case for deimplementation of low-value diagnostic services.
Collapse
Affiliation(s)
- Douglas J. Chieffe
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Steven A. Zuniga
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Surgery, Center for Quality Outcomes and Discovery (C-QODE), University of Minnesota, Minnesota, Minneapolis, USA
| | - Meredith E. Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
4
|
Souza WH, Grove CR, Gerend PL, Ryan C, Schubert MC. Regional differences in patient-reported outcomes as a proxy of healthcare practices for Americans living with vestibular symptoms. J Vestib Res 2022; 32:541-551. [PMID: 35811550 DOI: 10.3233/ves-220022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Geographical location is known to affect health outcomes; however, evidence regarding whether location affects healthcare for persons suspected to have vestibular dysfunction is lacking. OBJECTIVE To investigate whether location affects healthcare seeking and outcomes for adults with symptoms of vestibular pathology. METHODS We assessed for regional disparities associated with demographics, diagnosis, chronological factors, and financial expenditures from Americans who participated in the Vestibular Disorders Association registry (N = 905, 57.4±12.5 years, 82.7% female, 94.8% White, and 8.1% Hispanic or Latino). Respondents were grouped per geographical regions defined by the United States Census Bureau. RESULTS There were no significant between-region differences for age (p = 0.10), sex (p = 0.78), or ethnicity (p = 0.24). There were more Asian respondents in the West versus the Midwest (p = 0.05) and more Black respondents in the South versus the West (p = 0.05). The time to first seek care was shorter in the Northeast (17.3 [SD = 49.5] weeks) versus the South (42.4 [SD = 83.7] weeks), p = 0.015. The time from the first healthcare visit to receiving a final diagnosis was shorter in the Northeast (46.5 [SD = 75.4] weeks) versus the South (68.9 [SD = 89.7] weeks), p = 0.015. Compared to the Midwest, fewer respondents in the Northeast reported "no" out-of-pocket financial impact, p = 0.039. CONCLUSIONS Geographical location affects healthcare seeking and outcomes for persons suspected to have vestibular dysfunction.
Collapse
Affiliation(s)
- Wagner Henrique Souza
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Colin R Grove
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | | | - Cynthia Ryan
- VEDA Vestibular Disorders Association (VeDA), Portland, OR, USA
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
5
|
Gender-differences of proceduralists in perception of hand-held surgical instrument fit - A cross-sectional survey. Am J Surg 2022; 224:1482-1487. [PMID: 35606179 PMCID: PMC10066856 DOI: 10.1016/j.amjsurg.2022.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Determining perception of hand size as it relates to instrument use and ability to perform a procedure in a diverse population of proceduralists across surgical and medical specialties. METHODS Cross-sectional survey was distributed via electronic format to a convenience sample of surgeons/physicians. Secondary analysis included identified instrument use and choice of/perception of ability to learn and perform procedures. RESULTS 488 respondents, 84.4% (female), 75.8% (glove size ≤6.5), and 82.2% (surgical specialties). 67.8% reported trouble using surgical instruments, primarily endoscopes, laparoscopic instruments, and needle drivers. Latent class analysis identified two groups of female respondents with similar hand sizes but differ in the perception of their hand's abilities. CONCLUSIONS AND RELEVANCE Instruments beyond laparoscopic instruments do not fit all hands. Even among female with physicians with similar hand size, there is a sub-set who struggle using surgical tools. Beyond gender and hand size, the operator's perception of their hand and their ability is critical in determining the viability of instrument mastery.
Collapse
|
6
|
Jeong SS, Simpson KN, Johnson JM, Rizk HG. Assessment of the Cost Burden of Episodic Recurrent Vestibular Vertigo in the US. JAMA Otolaryngol Head Neck Surg 2022; 148:2797389. [PMID: 36227614 PMCID: PMC9562102 DOI: 10.1001/jamaoto.2022.3247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
Importance Understanding of the economic burden of recurrent vestibular causes of vertigo and areas contributing to the cost is needed. Objective To analyze and identify the factors contributing to the direct medical costs associated with Ménière disease (MD), vestibular migraine (VM), and benign paroxysmal positional vertigo (BPPV). Design, Setting, and Participants This economic evaluation used MarketScan Commercial Database claims data from 2018 to identify the non-Medicare patient population with the diagnoses of MD, VM, or BPPV. Data were analyzed January 1 to December 31, 2018. Main Outcomes and Measures The total direct medical costs associated with MD, VM, and BPPV. Results A total of 53 210 patients (mean [SD] age, 47.8 [11.8] years; 67.6% female) were included in this study, with 34 738 normal comparisons. There were 5783 (10.9%) patients with MD, 3526 (6.6%) patients with VM, and 43 901 (82.5%) patients with BPPV in the data set. Mean age and sex were different across the different vestibular disorders. Across the different groups, patients with no comorbidities or with a Charlson Comorbidity Index score of zero ranged from 98.4% to 98.8%. Around 5% of patients were hospitalized with inpatient stay lasting between 4.6 and 5.2 days. After adjusting for age, sex, and comorbidities, there were large differences in mean adjusted annual payments/direct costs across the different groups (MD, $9579; VM, $11 371; and BPPV, $8247). This equated to a total incremental estimated cost of $60 billion compared with the normal population. The number of outpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 20, while the number of inpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 6. A heat map of the total cost expenditure indicated that the costs were concentrated around the Midwest, Lake Michigan, and the East Coast. Conclusions and Relevance In this economic evaluation, the 3 most common causes of recurrent vertigo-MD, VM, and BPPV-had considerable medical costs associated with them. Extraneous imaging orders and vestibular testing are factors to consider for cost reduction. However, further research and widespread education is needed to optimize the diagnosis, treatment, and care of patients presenting with vestibular disorders or dizziness.
Collapse
Affiliation(s)
- Seth S. Jeong
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston
- Albert Einstein College of Medicine, Bronx, New York
| | - Kit N. Simpson
- Comparative Effectiveness Data Analytic Resource Core, College of Health Professions, Medical University of South Carolina, Charleston
| | - Jada M. Johnson
- Comparative Effectiveness Data Analytic Resource Core, College of Health Professions, Medical University of South Carolina, Charleston
| | - Habib G. Rizk
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston
| |
Collapse
|
7
|
Swan AA, Akin FW, Amuan ME, Riska KM, Hall CD, Kalvesmaki A, Padilla S, Crowsey E, Pugh MJ. Disruptive Dizziness Among Post-9/11 Veterans With Deployment-Related Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:199-212. [PMID: 34320551 DOI: 10.1097/htr.0000000000000714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify disruption due to dizziness symptoms following deployment-related traumatic brain injury (TBI) and factors associated with receiving diagnoses for these symptoms. SETTING Administrative medical record data from the Department of Veterans Affairs (VA). PARTICIPANTS Post-9/11 veterans with at least 3 years of VA care who reported at least occasional disruption due to dizziness symptoms on the comprehensive TBI evaluation. DESIGN A cross-sectional, retrospective, observational study. MAIN MEASURES International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes of dizziness, vestibular dysfunction, and other postconcussive conditions; neurobehavioral Symptom Inventory. RESULTS Increased access to or utilization of specialty care at the VA was significant predictors of dizziness and/or vestibular dysfunction diagnoses in the fully adjusted model. Veterans who identified as Black non-Hispanic and those with substance use disorder diagnoses or care were substantially less likely to receive dizziness and vestibular dysfunction diagnoses. CONCLUSIONS Access to specialty care was the single best predictor of dizziness and vestibular dysfunction diagnoses, underscoring the importance of facilitating referrals to and utilization of specialized, comprehensive clinical facilities or experts for veterans who report disruptive dizziness following deployment-related TBI. There is a clear need for an evidence-based pathway to address disruptive symptoms of dizziness, given the substantial variation in audiovestibular tests utilized by US providers by region and clinical specialty. Further, the dearth of diagnoses among Black veterans and those in more rural areas underscores the potential for enhanced cultural competency among providers, telemedicine, and patient education to bridge existing gaps in the care of dizziness.
Collapse
Affiliation(s)
- Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio, San Antonio (Dr Swan and Ms Crowsey); South Texas Veterans Health Care System, San Antonio (Dr Swan); James H Quillen VA Medical Center, Mountain Home, Tennessee (Drs Akin and Hall); Departments of Audiology and Speech Language Pathology (Dr Akin) and Rehabilitative Sciences (Dr Hall), East Tennessee State University, Johnson City; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah (Mss Amuan and Padilla and Drs Kalvesmaki and Pugh); Department of Internal Medicine, University of Utah, Salt Lake City (Mss Amuan and Padilla and Drs Kalvesmaki and Pugh); Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina (Dr Riska); and Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina (Dr Riska)
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Adams ME, Marmor S. Dizziness Diagnostic Pathways: Factors Impacting Setting, Provider, and Diagnosis at Presentation. Otolaryngol Head Neck Surg 2022; 166:158-166. [PMID: 33845655 PMCID: PMC9258633 DOI: 10.1177/01945998211004245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Ensuring that patients with dizziness present to the most appropriate level of care and provider are key goals of quality and cost improvement efforts. Using a symptom-defined cohort of adults presenting for dizziness evaluations, we aimed to identify patient factors associated with ambulatory clinic vs emergency department (ED) presentations, evaluating provider specialty, and assigned diagnoses. STUDY DESIGN Cross-sectional study. SETTING OptumLabs Data Warehouse (OLDW), a longitudinal, real-world data asset with deidentified administrative claims. METHODS We performed a cross-sectional analysis of adults (older than 18 years) who received new dizziness diagnoses (2006-2015) and identified factors associated with setting and provider at initial presentation using multivariable regression models. RESULTS Of 805,454 individuals with dizziness (median age 52 years, 62% women, 29% black, Asian, or Hispanic), 23% presented to EDs and 77% to clinics (76% primary care, 7% otolaryngology, 5% cardiology, 3% neurology). Predictors of ED presentation were younger age, male sex, black race, lower education, and medical comorbidity. Predictors of primary care clinic presentation were older age and race/ethnicity other than white. Nonetiologic symptom diagnoses alone were assigned to 51% and were most associated with age older than 75 years (odds ratio, 2.90; 95% CI, 2.86-2.94). CONCLUSION Adults with dizziness often present to a level of care that may be higher than is optimal. Differential care seeking and diagnoses by age, sex, and race/ethnicity reflect influences beyond dizziness presentation acuity. Targeted patient resources, triage systems, provider education, and cross-specialty partnerships are needed to direct dizzy patients to appropriate settings and providers to improve care.
Collapse
Affiliation(s)
- Meredith E. Adams
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA,Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA,Center for Clinical Quality and Outcomes Discovery and Evaluation (CQODE), University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
9
|
Vanstrum EB, Doherty JK, Sinha UK, Voelker CCJ, Bassett AM. An Exploration of Online Support Community Participation Among Patients With Vestibular Disorders. Laryngoscope 2021; 132:1835-1842. [PMID: 34889460 DOI: 10.1002/lary.29969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/03/2021] [Accepted: 11/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To formally document online support community (OSC) use among patients with vestibular symptoms and gain an appreciation for the perceived influence of participation on psychosocial outcomes and the impact on medical decision-making. STUDY DESIGN Self reported internet-based questionnaire. METHODS The Facebook search function was paired with a comprehensive list of vestibular diagnoses to systematically collect publicly available information on vestibular OSCs. Next, a survey was designed to gather clinicodemographic information, OSC characteristics, participation measures, perceived outcomes, and influence on medical decision-making. The anonymous instrument was posted to two OSCs that provide support for patients with general vestibular symptoms. RESULTS Seventy-three OSCs were identified with >250,000 cumulative members and >10,000 posts per month. The survey was completed by 549 participants, a cohort of primarily educated middle-aged (median = 50, interquartile range 40-60), non-Hispanic white (84%), and female (89%) participants. The participants' most cited initial motivation and achieved goal of participants was to hear from others with the same diagnosis (89% and 88%, respectively). Daily users and those who reported seeing ≥5 providers before receiving a diagnosis indicated that OSC utilization significantly influenced their requested medical treatments (72% daily vs. 61% nondaily, P = .012; 61% <5 providers vs. 71% ≥5 providers P = .019, respectively). Most participants agreed that OSC engagement provides emotional support (74%) and helps to develop coping strategies (68%). Membership of ≥1 year was associated with a higher rate of learned coping skills (61% membership <1-year vs. 71% ≥1-year P = .016). CONCLUSIONS The use of OSCs is widespread among vestibular diagnoses. A survey of two OSCs suggests these groups provide a significant source of peer support and can influence users' ability to interface with the medical system. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
Collapse
Affiliation(s)
- Erik B Vanstrum
- Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Joni K Doherty
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Uttam K Sinha
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Courtney C J Voelker
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Alaina M Bassett
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| |
Collapse
|
10
|
Fife TD, Desmond AL, Kerber KA. Coding and Reimbursement for Vestibular Tests by the U.S. Centers for Medicare and Medicaid Services (CMS). Otol Neurotol 2021; 42:e1544-e1547. [PMID: 34766950 DOI: 10.1097/mao.0000000000003314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coding and insurance reimbursement is a part of the healthcare system in the United States but is subject to periodic modifications. In addition to changes in the evaluation and management (E/M) codes that took effect in 2021, there are some differences in coding for some diagnostic vestibular function test procedures. Two new codes for vestibular myogenic evoked potential testing were added and previous codes for auditory evoked potential codes 92585 and 92586, which some facilities had used to bill for vestibular myogenic evoked potential testing, have been eliminated. This article outlines the current state of coding and reimbursement by CMS for vestibular procedures.
Collapse
Affiliation(s)
- Terry D Fife
- Barrow Neurological Institute
- University of Arizona College of Medicine - Phoenix, Phoenix, Arizona
| | - Alan L Desmond
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kevin A Kerber
- University of Michigan Healthcare System, Ann Arbor, Michigan
| |
Collapse
|
11
|
Weinreich HM, Martin E, Agrawal Y. Overview of Dizziness in Practice. Otolaryngol Clin North Am 2021; 54:839-852. [PMID: 34538358 DOI: 10.1016/j.otc.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The evaluation of dizziness as a chief complaint can be exceptionally challenging to otolaryngologists. The critical piece in evaluating dizzy patients is to have a plan for how to screen and schedule, how to gather data, and to develop a workflow for testing that allows clinical efficiency. This article provides an overview of evidence-based practices on how to screen dizzy patients before being scheduled, how to efficiently move patients through the otolaryngologist's clinic, and strategies for managing a dizzy practice.
Collapse
Affiliation(s)
- Heather M Weinreich
- Department of Otolaryngology Head and Neck Surgery, University of Illinois at Chicago, 1855 West Taylor Street, Chicago, IL 60612, USA.
| | - Emma Martin
- Department of Otolaryngology Head and Neck Surgery, University of Illinois at Chicago, 1855 West Taylor Street, Chicago, IL 60612, USA
| | - Yuri Agrawal
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, 601 North Caroline Street, 6th Floor JHOC, Baltimore, MD 21287, USA. https://twitter.com/yuriagrawal
| |
Collapse
|
12
|
Zuniga SA, Marmor S, Adams ME. Variation in Canalith Repositioning Procedure Use Among Medicare Beneficiaries: Understanding the Role of Geographic Region and Provider Specialty. Otol Neurotol 2021; 42:e911-e917. [PMID: 34260509 PMCID: PMC9258631 DOI: 10.1097/mao.0000000000003112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Clinical practice guidelines recommend canalith repositioning procedures (CRPs) for the management of benign paroxysmal positional vertigo (BPPV). As only 10 to 20% of affected individuals receive CRPs, there is concern for guideline adherence and knowledge dissemination to relevant medical specialties. This study aimed to characterize patterns of CRP utilization over time, across all United States regions, and by provider specialty. STUDY DESIGN Cross-sectional analysis with time trends of CRP claims in the Centers for Medicare and Medicaid Service Provider Utilization and Payment database, 2012 to 2017. SETTING National administrative claims data. PATIENTS Fee-for-service Medicare beneficiaries. INTERVENTIONS Canalith repositioning procedures. MAIN OUTCOME MEASURES CRP utilization was analyzed by year, hospital referral region (HRR), and provider specialty. RESULTS From 2012 to 2017, 253,894 CRPs were performed on 146,139 Medicare beneficiaries and CRP utilization increased 80%. CRP use varied widely by geographic region. In 2017, CRP use per 100,000 beneficiaries varied 113-fold across HRRs (range, 6.0-701.8, interquartile range, 68.4, extremal ratio, 116.9). Most CRPs were performed by otolaryngologists (50.9%) and physical therapists (34.3%) with few by primary care providers (1.3%). CONCLUSIONS CRP utilization increased substantially suggesting improved dissemination and implementation of BPPV management guidelines. Nevertheless, wide geographic and provider-level variation remained, signifying non-uniform provider practices and access to care. Care for BPPV may thus be improved through education and incentivization of a broader range of providers.
Collapse
Affiliation(s)
| | - Schelomo Marmor
- Department of Otolaryngology-Head and Neck Surgery
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | | |
Collapse
|
13
|
Abstract
While the majority of vestibular disorders may be diagnosed solely on clinical grounds, a variety of clinical scenarios exist in which objective functional assessment of the vestibular system provides data that facilitate diagnosis and treatment decisions. There exists a veritable armamentarium of sophisticated vestibular test modalities, including videonystagmography, rotary chair testing, video head impulse testing, and vestibular-evoked myogenic potentials. This article aims to help clinicians apply an accessible decision-making rubric to identify the clinical scenarios that may and may not benefit from data derived from specific vestibular function tests.
Collapse
Affiliation(s)
- Steven A Zuniga
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA.
| | - Meredith E Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA
| |
Collapse
|