Understanding the Composition of a Comprehensive Otolaryngologist's Practice Through Medicare Reimbursements.

Abstract

With a rising number of otolaryngology (ORL) graduates completing a fellowship, the number of generalists (also known as comprehensive ORLs [c-ORLs]), arguably the group of ORLs most needed, is likely to decrease. However, the practice and reimbursement patterns of c-ORLs have yet to be examined. Cross-sectional retrospective analysis. 2019 Medicare Provider Utilization and Payment Datasets. All ORLs were isolated (n = 8959), and then a random 10% sample was obtained. These 897 ORLs were queried for fellowship completion, isolating out those who have not completed a fellowship, and characterizing their practice patterns with regards to Medicare, the largest insurer in the US. Within the random sample, 554 (61.8%) were c-ORLs, of which 47 (8.5%) practiced in an academic setting. c-ORLs billed a mean of 52.9 (SD: 26.6) Current Procedural Terminology (CPT), and community-based c-ORLs had a more diverse practice (P < .001). On average, Medicare paid $138,942 ($117,563) to each c-ORL for 1982.2 (2614.7) services for 451.7 (296.9) patients. Ninety-five percent of their total reimbursements were office-based. Of 250 unique CPT codes billed, 52.8% of all c-ORLs reimbursements were from evaluation and management services, 17.8% from rhinology, 9.7% from otology/neurotology, and 9% from laryngology. Though surgery is an integral aspect of all ORLs' training and practice, c-ORLs practice in a largely office-based setting, at least with regard to Medicare patients. While c-ORLs clearly practice with a diverse skill set, their reimbursement patterns suggest rhinology makes up the largest proportion of their procedural practice.