(0110) Trends in Medicare Reimbursement of Otolaryngology Procedures in Ambulatory Surgery Centers

Introduction: The purpose of this study was to characterize Medicare reimbursement trends for otolaryngology procedures performed in Ambulatory Surgery Centers (ASCs).

Methods: This retrospective, cross-sectional analysis used CMS’ ASC Facility Fee Schedule to determine the inflation-adjusted annual reimbursement rate from 2010 to 2023 for 69 common otolaryngology procedures. Procedures were chosen based on their Medicare volume in 2010, 2015, 2019, and 2020 and the co-authors’ experiences in ASC management. These four years accounted for data availability, annual procedural shifts, and COVID's impact. For each procedure, the year-to-year percent change for each pair of years between 2010 and 2023 was calculated and then averaged. This study investigated year-to-year change rather than the difference between the first and last year in the date range to account for annual fluctuations throughout the entire date range. Lastly, a weighted average of the year-to-year change for each procedure group was calculated. Each procedure was weighted according to the combined Medicare volume.

Results: The weighted average year-to-year percent change for all procedures in this analysis was 1.33%. When grouped by subspecialty, it was 1.51% for facial plastics, -0.45% for general, 0.55% for head and neck, 1.83% for laryngology, -1.57% for otology, and 1.54% for rhinology.

Conclusions: This research is the first to assess Medicare reimbursement trends for otolaryngology in the ASC setting. While there has been a notable decline in reimbursement under the Physician Fee Schedule, the ASC Facility Fee Schedule has shown a slight increase from 2010 to 2023. Because total ASC reimbursement for a procedure depends on these two fee schedules, further exploration into the economic sustainability of these trends is essential, especially considering rising healthcare costs.