Understanding the Composition of a Comprehensive Otolaryngologist’s Practice

Introduction: With a rising number of otolaryngology (ORL) graduates opting to complete a fellowship, the number of true generalists (also known as comprehensive ORLs [c-ORLs]), arguably the group of ORLs most needed, is likely to decrease. However, the practice patterns and reimbursement patterns of comprehensive ORLs has yet to be examined.

Methods: Retrospective analysis of the 2019 Medicare Provider Utilization and Payment Datasets was performed. All ORLs were isolated (n=8959), and then a random 10% sample was obtained. These 897 ORLs were searched on the internet 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. Total Medicare reimbursements, patients, and services were gathered. Current procedural terminology (CPT)-specific data was only available for CPTs billed >10 times on >10 patients.

Results: Within our random sample, there were 546 (60.8%) c-ORLs, of which 47 (8.6%) practiced in an academic setting. c-ORLs billed a mean of 53.4 (SD: 26.3) CPTs, and community-based c-ORLs had a more diverse practice (p=0.003). Medicare paid an average of $140,704 ($117,389) to each c-ORL for a mean of 2,004 (2,623) services on 457 (295) patients. Of all services provided, 87.4% had CPT-specific data. Of these, 96.3% of their billed CPTs were office-based, with only 3.7% done in a facility, and 95% of their total reimbursements were office-based. Between all the c-ORLs, there were 250 unique CPT codes billed; when grouped, 52.8% of all c-ORLs reimbursements were from established patient visits (i.e., CPT codes 99201-99215), 17.8% rhinology, 9.7% otology/neurotology, 9% laryngology, and 4.8% allergy.

Conclusions: Though surgery is an integral aspect of all ORL's training and practice, c-ORLs uniquely practice in a largely office-based setting, at least with regards 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 practice.