Financial Impact of Medicare Payment Reform for E/M Visits on Compensation for Otolaryngologic Procedures

Introduction: The Centers for Medicare & Medicaid Services (CMS) recently increased payment for outpatient (2021) and inpatient (2023) evaluation and management (E/M) visits, but did not apply these updates to post-operative global period visits. We investigated the resulting Medicare fee-for-service revenue loss for otolaryngologists.

Methods: We estimated how much additional payment otolaryngologists would have received in 2023 if CMS had reimbursed 10- and 90-day global period visits at the same rates as other E/M visits. Our estimates were based on publicly available CMS data summarizing procedural spending (Physician/Supplier Procedure Summary dataset [PPS]) , utilization (PPS), and pricing (Time File and Physician Fee Schedule). We categorized all procedures into the following mutually-exclusive disease areas: ablative head & neck, voice/airway/swallowing, otology, facial plastic/reconstructive, rhinology, skull base, sleep, and other.

Results: Our analysis included 291 procedures with 10- or 90-day global periods. The total estimated global period revenue loss was $7.0M and concentrated among facial plastic/reconstructive ($3.3M; 47.1%), ablative head & neck ($1.5M; 21.4%), and otologic ($1.2M; 17.1%) procedures. Relative to actual 2023 Medicare spending, estimated revenue loss was greatest for skull base ($0.1M of $1.4M; 6.9%) and facial plastics/reconstructive ($3.3M of $48.3M; 6.8%). At the procedure level, total estimated losses were greatest for nasal septoplasty (CPT 30520; $1.2M), tympanostomy with ventilating tube placement (CPT 69433; $0.6M), and cervical lymphadenectomy (CPT 38724; $0.5M).

Conclusions: CMS’ recent policy presumes physician work is uniformly less valuable during global periods, with financial ramifications for otolaryngologists. Payment reforms based on robust and empirically-derived measures of physician work are necessary to promote fair procedural compensation.