The Price of Otologic Procedures: Variation in Markup by Surgical Procedure and Geography in the United States. Issue 8 (26th September 2021)

• Record Type: Journal Article
• Authors: Bu, Daniel D.; Schwam, Zachary G.; Neifert, Sean N.; Ferrandino, Rocco; Kaul, Vivian Z.; Perez, Enrique; Wanna, George B.; Cosetti, Maura K.
• Is Part Of: Otology & neurotology. Volume 42:Issue 8(2021)
• Page Start: 1184
• Page End: 1191
• Publication Date: 2021-09-26
• Subjects: Boneanchored hearing aid -- Cochlear implant -- Markup ratio -- Mastoidectomy -- Myringotomy -- Regional variation -- Stapedotomy/stapedectomy -- Tympanomastoidectomy -- Tympanoplasty; Otology -- Periodicals; Ear -- Diseases -- Periodicals; Skull base -- Surgery -- Periodicals; 617.8005
• DOI: 10.1097/MAO.0000000000003151
• Languages: English
• ISSNs: 1531-7129

Abstract

Abstract : Supplemental Digital Content is available in the text Abstract : Objective: To characterize and analyze variation in price markup of seven common otologic surgeries by procedure and geographic region. Study Design: Retrospective Analysis of the Centers for Medicare and Medicaid Services database of 2017 Medicare Provider Utilization and Payment Public File. Setting: Inpatient and outpatient centers delivering Medicare-reimbursed services. Patients: Full sample of patients undergoing procedures with Medicare fee-for-service final action claims during 2017. Interventions: Seven procedures (myringotomy, tympanoplasty, mastoidectomy, tympanomastoidectomy stapedotomy/stapedectomy, cochlear implant, bone-anchored hearing aid). Main Outcome Measures: Markup ratio (MUR) is defined as the ratio of total charges to Medicare-allowable-costs; Variation in MUR was measured using coefficient of variation (CoV). Results: Among all providers, the median MUR was 2.4 (interquartile range: 1.9–3.1). MUR varied significantly by procedure, from 2.3 for myringotomy to 8.7 for mastoidectomy ( p < 0.01). MUR also varied significantly within procedure, with the least variation found in myringotomy (CoV = 0.46), and the greatest in cochlear implants (CoV = 0.92). Using the national average as baseline, MUR varied 71% between states, ranging from 1.75 to 6.24. Within the same state, significant variation was also noted, varying by 4% (CoV = 0.04) in Montana compared with 138% (CoV = 1.38) in Pennsylvania. MUR was not significantly correlated with patient comorbidity or Centers for Medicare and Medicaid Services risk scores. Conclusions: There was significant variation in the price of otologic surgery across geographic regions and procedures. The MUR for otology is lower or comparable to that reported in other surgical fields.