Medicare reimbursement trends from 2000 to 2020 in head and neck surgical oncology

Medicare volume and reimbursement trends in lingual and hyoid procedures for obstructive sleep apnea

OBJECTIVES

This study aims to analyze utilization and reimbursement trends in lingual and hyoid surgery for obstructive sleep apnea (OSA).

METHODS

Annual retrospective data on lingual and hyoid OSA surgeries was obtained from the 2000-2021 Medicare Part B National Summary Datafiles. Current Procedural Terminology (CPT) codes utilized included 21,685 (hyoid myotomy and suspension [HMS]), 41,512 (tongue base suspension [TBS]), 41,530 (radiofrequency ablation of the tongue [RFT]) and 42,870 (lingual tonsillectomy [LT]).

RESULTS

The number of lingual and hyoid OSA surgeries rose 2777 % from 121 in 2000 to 3481 in 2015, before falling 82.9 % to 594 in 2021. Accordingly, Medicare payments rose 17,899 % from an inflation-adjusted $46,958 in 2000 to $8.45 million in 2015, before falling drastically to $341,011 in 2021. As the number of HMSs (2000: 91; 2015: 84; 2021: 165), TBS (2009: 48; 2015: 31; 2021: 16), and LTs (2000: 121; 2015: 261; 2021: 234) only experienced modest changes in utilization, this change was largely driven by RFT (2009: 340; 2015: 3105; 2021: 179). Average Medicare payments for RFT rose from $1110 in 2009 to $2994 in 2015, before falling drastically to $737 in 2021.

CONCLUSION

Lingual and hyoid surgery for OSA has overall fallen in utilization among the Medicare population from 2000 to 2021. However, there was a brief spike in usage, peaking in 2015, driven by the adoption (and then quick dismissal) of RFT. The rise and fall in RFT use coincide with the rise and fall in reimbursement.

Trends in Medicare utilization and reimbursement for hematology/oncology procedures from 2012 to 2023: A geriatric oncology perspective

Objectives

Given the scarcity of data exploring reimbursement trends in the field of hematology/oncology, we sought to characterize these trends for common procedures in this field from 2012 to 2023.

Methods

Using the Centers for Medicare and Medicaid Services' Physician Fee Schedule Look-Up Tool we collected reimbursement data for 40 hematology/oncology procedure codes from 2012 to 2023. Data was adjusted to 2023 United States (US) dollars using the Consumer Price Index (CPI).

Results

From 2012 to 2023 gross reimbursement for the facility price decreased 4.4% and increased 9.2% for the non-facility price. When adjusted for inflation, compensation decreased 96.1% and 96.6%, respectively. None of the 40 examined Current Procedural Terminology (CPT) codes increased in net reimbursement over the study period.

Conclusions

Medicare reimbursement for common hematology/oncology procedures decreased from 2012 to 2023. Further research is necessary to explore the implications of these trends on the delivery of patient care.

Trends in Medicare Reimbursements for Commonly Performed Laryngeal Procedures from 2000 to 2021

OBJECTIVE

Numerous studies among different specialties have suggested that inflation-adjusted Medicare reimbursements have steadily declined in the last few decades. The objective of this study is to investigate whether this is true within the field of laryngology.

STUDY DESIGN

Retrospective Cross-Sectional Study.

SETTING

Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule.

METHODS

2000-2021 fees for laryngeal surgeries (Current Procedural Terminology [CPT] codes 31530, 31531, 31535, 31536, 31540, 31541, 31545, 31546, 31551-31554, 31560, 31561, 31570), and laryngectomies (CPTs 31360, 31365, 31367, 31368, 31370, 31375, 31380, 31382, 31390, 31395) were gathered. United States consumer price index (CPI) was used to adjust all gathered data for inflation to 2021 US dollars.

RESULTS

During the study period, unadjusted reimbursement for non-facility and facility laryngeal surgeries decreased an average of 6.1% and 6.6%, respectively. When adjusting for inflation, non-facility and facility laryngeal surgeries saw an average decrease of 17.8% (p < 0.001) and 28.5% (p < 0.001), respectively. Unadjusted reimbursement for facility laryngectomies saw an average increase of 40.2%, correlating to an inflation-adjusted decline of 8.9% (p < 0.001). Among laryngeal procedures overall, there was an average nominal increase of 17.0%, correlating to a 20.3% inflation-adjusted decline.

CONCLUSION

In terms of inflation-adjusted dollars, reimbursements for laryngeal procedures have seen a large decrease in the last two decades. Understanding reimbursement trends is critical for sustainability of otolaryngology practices, and can be used by surgeons, hospital systems, and policymakers to guide future healthcare legislation.

A Medicare Physician Fee Schedule Analysis of Reimbursement Trends in Laryngology from 2000 to 2021

OBJECTIVE

The purpose of this study is to characterize Medicare reimbursement trends for laryngology procedures over the last two decades.

METHODS

This analysis used CMS' Physician Fee Schedule (PFS) Look-Up Tool to determine the reimbursement rate of 48 common laryngology procedures, which were divided into four groups based on their practice setting and clinical use: office-based, airway, voice disorders, and dysphagia. The PFS reports the physician service reimbursement for "facilities" and global reimbursement for "non-facilities". The annual reimbursement rate for each procedure was averaged across all localities and adjusted for inflation. The compound annual growth rate (CAGR) of each procedure's reimbursement was determined, and a weighted average of the CAGR for each group of procedures was calculated using each procedure's 2020 Medicare Part B utilization.

RESULTS

Reimbursement for laryngology procedure (CPT) codes has declined over the last two decades. In facilities, the weighted average CAGR for office-based procedures was -2.0%, for airway procedures was -2.2%, for voice disorders procedures was -1.4%, and for dysphagia procedures was -1.7%. In non-facilities, the weighted average CAGR for office-based procedures was -0.9%. The procedures in the other procedure groups did not have a corresponding non-facility reimbursement rate.

CONCLUSION

Like other otolaryngology subspecialties, inflation-adjusted reimbursements for common laryngology procedures have decreased substantially over the past two decades. Because of the large number of physician participants and patient enrollees in the Medicare programs, increased awareness and further research into the implications of these trends on patient care is necessary to ensure quality in the delivery of laryngology care.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:247-256, 2024.

Retrospective analysis shows the cost of Mohs surgery decreases when adjusted for medical inflation

BACKGROUND

Mohs surgery (MS) is the gold standard for treating nonmelanoma skin cancers in cosmetically sensitive areas.

OBJECTIVE

To investigate MS costs over time when adjusting for medical inflation while considering the perspective of patients, payers, and health care systems.

METHODS

A retrospective claim analysis using data from the International Business Machines MarketScan Commercial Claims and Encounters Database from 2007 through 2019 was performed. A query of the database for any instance of a MS-specific Current Procedural Terminology (CPT) code in adults (17311, 17312, 17313, 17314, and 17315) was conducted. Aggregate data per claim regarding coinsurance, total cost, deductible, copay, and insurance payout were provided for each CPT code annually.

RESULTS

The total adjusted cost per claim decreased significantly (P < .001) for 4 of the 5 MS-specific CPT codes between 2007 and 2019: 17311 (-25%), 17312 (-15%), 17313 (-25%), and 17314 (-18%). The patient's adjusted out-of-pocket expense increased significantly (P < .0001) for 4 of the 5 MS-specific CPT codes: 17311 (33%), 17312 (45%), 17313 (34%), and 17314 (43%).

CONCLUSION

Among the 4 most used MS-specific CPT codes (17311, 17312, 17313, and 17314), the total cost per claim decreased and the patient's out-of-pocket expense increased from 2007 to 2019.