Medical Student Frank H. Netter MD School of Medicine Burlingon, New Jersey
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the Medicare utilization, billing practices, reimbursement rates, and patient populations of otolaryngology physicians practicing in rural and urban settings as well as social and economic factors that may affect billing practices based on geography.
Objectives: To compare Medicare utilization, billing practices, reimbursement rates, and patient populations of otolaryngology physicians (ORLs) practicing in rural and urban settings.
Study Design:Cross-sectional analysis of the 2019 Medicare Provider Utilization and Payment datasets.
Methods: Total and mean number of Medicare patients, services, total unique Healthcare Common Procedure Coding System (HCPCS) codes billed, and Medicare reimbursement were gathered along with patient population comorbidity statistics and average hierarchical condition category (HCC) risk scores.
Results: In 2019, 92% of 8,959 ORLs practiced in an urban setting. These urban ORLs, on average, billed for 51 (IQR:31-67) unique HCPCS codes, cared for 393 (IQR:172-535) Medicare patients, performed 1761 (502-2070) services, and collected $139,957 (IQR: $55,527-$178,479) per provider. In contrast, rural ORLs, on average, billed for a larger number of unique HCPCS codes (59; IQR: 37-77; p<0.001), treated more Medicare patients (445; IQR: 242-614; p<0.001), and performed more services (2330; IQR: 694-2748; p<0.001), but did not collect more per provider ($141,035; IQR: $56,555-$172,864; p=0.426) per provider. The variety and complexity of procedures performed by ORLs was similar in both settings, as was the patient comorbidity profile. ORLs practicing in an urban setting saw, on average, patients with a significantly higher HCC risk score (p < 0.001).
Conclusions: Despite performing procedures of the same variety and complexity, as well as billing for significantly more unique HCPCS codes, Medicare patients, and services per provider, rural ORLs were not reimbursed significantly more per provider when compared to urban ORLs. This may indicate that rural ORLs are reimbursed at decreased levels.