1
|
Corbisiero MF, Muffly TM, Gottman DC, Olson M, Hachicha Y, Garcia-Creighton E, Gallego N, Elsayed M, Ahmed S, Cabrera-Muffly C. Insurance Status and Access to Otolaryngology Care: National Mystery Caller Study in the United States. Otolaryngol Head Neck Surg 2024. [PMID: 38606652 DOI: 10.1002/ohn.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/23/2024] [Accepted: 02/09/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To investigate potential differences in new patient appointment wait times for otolaryngology care based on insurance types and explore factors influencing these wait times. STUDY DESIGN A cross-sectional audit study, using a "mystery caller" approach, analyzed with a linear mixed Poisson model to adjust for confounding factors. SETTING A total of 612 physicians across 49 states and the District of Columbia, representing 6 otolaryngology subspecialties, were included. METHODS Otolaryngology physicians were contacted by mystery callers via telephone with scripted clinical vignettes as patients with either Medicaid or Blue Cross/Blue Shield (BCBS) insurance. Callers requested next available appointment. Wait times for new patient appointments were recorded and analyzed in R using a generalized linear mixed Poisson model. RESULTS A total of 1183 of 1224 calls reached a representative. Medicaid patients waited 5.73% longer (P < .001) compared to BCBS patients (IRR: 1.06; confidence interval [CI]: 1.03-1.09; P < .001), with respective mean wait times of 36.8 days (SE ± 1.6) and 32.4 days (SE ± 1.6). Longer waiting times were also associated with physicians affiliated with universities (P = .001) and certain subspecialties, such as pediatric otolaryngology (P < .001) and neurotology (P = .008). Regional differences were also observed, with specific AAO-HNS regions showing shorter wait times. The model achieved a conditional R-squared value of 0.947. CONCLUSION This study reveals disparities in wait times for otolaryngology care based on insurance type, with extended wait times for Medicaid beneficiaries. The findings highlight a potential access to care disparity, which begets the need for strategies that ensure equitable access to otolaryngology care and further research to understand the underlying reasons for these potential disparities.
Collapse
Affiliation(s)
| | - Tyler M Muffly
- Denver Health Hospital and Authority, Denver, Colorado, USA
| | - Drew C Gottman
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Madeline Olson
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Yasmine Hachicha
- New York University, School of Public Health, New York, New York, USA
| | | | | | - Maryam Elsayed
- New York University, School of Public Health, New York, New York, USA
| | - Sophia Ahmed
- Villanova University, College of Liberal Arts and Sciences, Villanova, Pennsylvania, USA
| | - Cristina Cabrera-Muffly
- University of Colorado Department of Otolaryngology-Head and Neck Surgery, Aurora, Colorado, USA
| |
Collapse
|
2
|
Pozin M, Nyaeme M, Peterman N, Jagasia A. Geospatial evaluation of access to otolaryngology care in the United States. Laryngoscope Investig Otolaryngol 2024; 9:e1239. [PMID: 38525122 PMCID: PMC10960241 DOI: 10.1002/lio2.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/25/2023] [Accepted: 03/03/2024] [Indexed: 03/26/2024] Open
Abstract
Objectives This county-level epidemiological study evaluated the travel distance to the nearest otolaryngologist for continental US communities and identified socioeconomic differences between low- and high-access regions. Methods Geospatial analysis of publicly available 2015-2022 NPI records was combined with US census data to identify geospatial gaps in otolaryngologist distribution. Moran's index geospatial clustering in distance to the nearest county with an otolaryngologist was used as the core metric for differential access determination. Univariate logistic analysis was conducted between low- and high-access counties for 20 socioeconomic and demographic variables. Results Nationally, the average person was 22 miles from an otolaryngologist. 444 counties were identified as geospatially "low access" with increased travel distance in the Midwest, Great Planes, and Nevada with a median of 47 miles. 1231 counties in the Eastern United States and Western Coast were identified as "high access" with a 3-mile median travel distance. Areas of low access to otolaryngological care had smaller median populations (12,963 vs. 558,306), had smaller percent Black and Asian populations (2% vs. 11%, 1% vs. 5%, respectively), had a greater percent American Indian population (2% vs. 1%), were less densely populated (8 vs. 907 people per square mile), had fewer percent college graduates (20% vs. 34%), and fewer otolaryngologists per county (median: 0.01-20). Conclusion These findings highlight disparity in otolaryngology care in the United States and the need for otolaryngology funding initiatives in the Midwest and Great Plains regions. Level of Evidence Level 3.
Collapse
Affiliation(s)
| | - Mark Nyaeme
- Carle Illinois College of MedicineUrbanaIllinoisUSA
| | | | - Ashok Jagasia
- Carle Illinois College of MedicineUrbanaIllinoisUSA
- Department of Otolaryngology‐Head and Neck SurgeryRush University Medical CenterChicagoIllinoisUSA
| |
Collapse
|
3
|
Krekelberg MO, Ruckart JD, Morton-Jones ME, Lacy AL, Madden LL, Ruckart KW. Evaluating Geographic Access to Interdisciplinary Laryngology and Speech-Language Pathology Clinic Models in the Southeast Region of the United States. J Voice 2023:S0892-1997(23)00327-2. [PMID: 37932131 DOI: 10.1016/j.jvoice.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE An interdisciplinary model of care for the evaluation and treatment of voice, swallowing, and upper airway disorders with laryngologists and specialized speech-language pathologists is known to increase revenue, attendance to visits, patient adherence, and most importantly, improve patient outcomes. Individuals who live outside of areas with high population density often have reduced geographic access to this specialized care. The primary aim of this study is to identify the percentage of the population that has an "extended drive time" to access an interdisciplinary clinic in the Southeast region of the United States. STUDY DESIGN NA. METHODS Interdisciplinary laryngology and speech-language pathology clinics were identified via publicly accessible information including an internet search and state department of public health databases. Included clinics had at least one full-time fellowship-trained laryngologist and at least one full-time speech-language pathologist on staff. Descriptive statistics and visual representation of the results were achieved with the use of Smappen, a location intelligence online platform, to identify the percent of the population with a drive time greater than 1 hour. RESULTS 47.24% of the Southeast population of the United States must drive over 1 hour to access an interdisciplinary clinic. Visual representations of these data are included and generated by Smappen. CONCLUSIONS While close geographic proximity does not ensure access to care, it can increase the likelihood that healthcare services will be used. This study identified the population in the Southeast region of the United States with extended drive time to interdisciplinary voice and swallowing centers due to their geographic distance from these centers. The results from this study support the need for increased geographic access to specialty care clinics, specifically voice, swallowing, and upper airway care, and provide insight into potential sites for interdisciplinary centers based on population density in areas that are underserved.
Collapse
Affiliation(s)
- Maris O Krekelberg
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - James D Ruckart
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Mariah E Morton-Jones
- Department of Otolaryngology, School of Kinesiology, Auburn University, Auburn, Alabama
| | - Alexa L Lacy
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Lyndsay L Madden
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kathryn W Ruckart
- Department of Otolaryngology-Head and Neck Surgery, Atrium Health Wake Forest Baptist/Wake Forest University School of Medicine, Winston-Salem, North Carolina.
| |
Collapse
|
4
|
Petrucci B, Okerosi S, Patterson RH, Hobday SB, Salano V, Waterworth CJ, Brody RM, Sprow H, Alkire BC, Fagan JJ, Tamir SO, Der C, Bhutta MF, Maina IW, Pang JC, Daudu D, Mukuzi AG, Srinivasan T, Pietrobon CA, Hao SP, Nakku D, Seguya A, Din TF, Mbougo OD, Mokoh LW, Jashek-Ahmed F, Law TJ, Holt EA, Bangesh AH, Zemene Y, Ibekwe TS, Diallo OR, Alvarado J, Mulwafu WK, Fenton JE, Agius AM, Doležal P, Mudekereza ÉA, Mojica KM, Rueda RS, Xu MJ. The Global Otolaryngology-Head and Neck Surgery Workforce. JAMA Otolaryngol Head Neck Surg 2023; 149:904-911. [PMID: 37651133 PMCID: PMC10472262 DOI: 10.1001/jamaoto.2023.2339] [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] [Received: 02/26/2023] [Accepted: 06/25/2023] [Indexed: 09/01/2023]
Abstract
Importance A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, Setting, and Participants A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main Outcome The OHNS workforce per capita, stratified by income and region. Results Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and Relevance This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.
Collapse
Affiliation(s)
| | - Samuel Okerosi
- Ear Nose and Throat Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Rolvix H. Patterson
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sara B. Hobday
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Valerie Salano
- Ear Nose and Throat Department, Nyahururu County Hospital, Nyahururu, Kenya
| | - Christopher J. Waterworth
- Nossal Institute for Global Health, Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert M. Brody
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
| | - Holly Sprow
- Tufts University School of Medicine, Boston, Massachusetts
| | - Blake C. Alkire
- Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston
| | - Johannes J. Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Sharon Ovnat Tamir
- Department of Otolaryngology/Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University of the Negev, Israel
| | - Carolina Der
- Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana de Santiago, Hospital Dr Luis Calvo Mackenna, Chile
| | | | - Ivy W. Maina
- Department of Otorhinolaryngology–Head & Neck Surgery, University of Pennsylvania, Philadelphia
| | - Jonathan C. Pang
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine
| | - Davina Daudu
- Faculty of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Allan G. Mukuzi
- Department of Otorhinolaryngology Head and Neck Surgery, University of Nairobi, Kenya
| | | | | | - Sheng-Po Hao
- Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Fu-Jen University, Taiwan
| | - Doreen Nakku
- Department of Otolaryngology Head and Neck Surgery, Mbarara University of Science and Technology, Uganda
| | - Amina Seguya
- Department of Otolaryngology Head and Neck Surgery, Mulago National Referral Hospital, Uganda
| | - Taseer F. Din
- Division of Pediatric Otolaryngology, Head-Neck Surgery, Department of Otolaryngology, Head-Neck Surgery, Stanford University, Stanford, California
| | | | - Lilian W. Mokoh
- Kenyatta University Teaching Research and Referral Hospital, Nairobi, Kenya
| | - Farizeh Jashek-Ahmed
- The International Center for Recurrent Head and Neck Cancer, the Royal Marsden Hospital, London, United Kingdom
| | - Tyler J. Law
- Department of Anesthesia & Perioperative Care, University of California, San Francisco
| | - Elizabeth A. Holt
- The Eisdell Moore Centre for Hearing and Balance Research, The University of Auckland, Auckland, New Zealand
| | | | - Yilkal Zemene
- St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Titus S. Ibekwe
- University of Abuja and University of Abuja Teaching Hospital, Abuja, Nigeria
| | | | | | - Wakisa K. Mulwafu
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - John E. Fenton
- Department of Otorhinlaryngology–Head and Neck Surgery, University of Limerick, Limerick, Ireland
| | - Adrian M. Agius
- Department of Otorhinolaryngology, University of Malta, Malta
| | - Pavel Doležal
- Department of Otorhinolaryngology and Head and Neck Surgery, Slovak Medical University, Bratislava, Slovakia
| | - Édouard Amani Mudekereza
- Hôpital Provincial Général de Référence de Bukavu, Université Catholique de Bukavu, Bukavu, Democratic Republic of the Congo
| | - Karen M. Mojica
- Department of otolaryngology, Vivian Pellas Hospital, Managua, Nicaragua
| | - Ricardo Silva Rueda
- Servicio de Otorrinolaringología, Bogota, Hospital Militar Central, Bogata, Colombia
| | - Mary Jue Xu
- Department of Anesthesia & Perioperative Care, University of California, San Francisco
- Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco
| |
Collapse
|
5
|
Patel RA, Torabi SJ, Kayastha D, Kuan EC, Manes RP. Medicare Utilization and Reimbursement Variation Between Rural and Urban Otolaryngologists. Otolaryngol Head Neck Surg 2023; 168:528-535. [PMID: 35852873 DOI: 10.1177/01945998221113550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare billing practices, reimbursement rates, and patient populations of otolaryngology (ORL) physicians practicing in rural and urban settings. STUDY DESIGN Retrospective cross-sectional study. SETTING Medicare Provider Utilization and Payment Data: Physician and Other Supplier Data. METHODS Medicare-allowed payments, number of services, and number of patients were gathered along with patient population comorbidity statistics, including average hierarchical condition category risk scores. RESULTS In 2019, 92% of the overall total 8959 ORL physicians practiced in an urban setting. These 8243 urban ORL physicians, on average, billed for 51 (interquartile range [IQR], 31-67) unique Healthcare Common Procedure Coding System (HCPCS) codes, cared for 393 (IQR, 172-535) Medicare patients, performed 1761 (IQR, 502-2070) services, and collected $139,957 (IQR, $55,527-$178,479) per provider. In contrast, the 704 rural ORL physicians, on average, billed for a greater number of unique HCPCS codes (59; IQR, 37-77; P < .001), treated more Medicare patients (445; IQR, 242-614; P < .001), and performed more services (2330; IQR, 694-2748; P < .001) but collected about the same per provider ($141,035; IQR, $56,555-$172,864; P = .426). Older age was associated with rural practice (P = .027). Among both urban and rural ORL physicians, the variety and complexity of procedures and patient comorbidity profiles were comparable. CONCLUSION Most ORL physicians practice in large urban settings, a finding potentially related to financial sustainability and career opportunity. With an already small workforce, the aging rural ORL physician population is an identifiable weak point in the otolaryngology specialty that must be addressed with geo-specific recruitment campaigns, rural work incentivization, and the development of career advancement opportunities in rural areas.
Collapse
Affiliation(s)
- Rahul A Patel
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, Connecticut, USA
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sina J Torabi
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - Darpan Kayastha
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, California, USA
| | - R Peter Manes
- Department of Surgery (Division of Otolaryngology), Yale University School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|