How do awake laryngology procedures in an endoscopy suite (ES) compare with like procedures performed in the operating room (OR) in terms of costs, charges, reimbursement, and efficiency?
Background: Office-based laryngology procedures have a favorable cost comparison with their OR counterparts. Although these comparisons are enticing, surgeon reimbursement rates for office-based procedures do not reliably cover associated clinic costs, pushing physicians back to the OR setting. Another alternative is to perform unsedated injection laryngoplasty (IL) and laser treatment (LT) of vocal fold lesions in a hospital-based ES facility.
Explore this issue:June 2016
Study design: Retrospective review of billing records comparing ES injection laryngoplasty and laser excision procedures and matched case controls in the OR.
Setting: Emory University School of Medicine, Atlanta, Georgia.
Synopsis: Third-party payers consisted of 60% managed care/40% Medicare for ES procedures, and 80% managed care/20% Medicare for OR procedures. Mean total reimbursement for all ES procedures was $2,010.00 versus $2,611.00 for OR procedures. Hospital expenses were significantly lower for ES procedures. The mean cost of an ESIL procedure was $1,737 versus $2,231 for ORIL. The average cost of an ESLT procedure was $1,465 versus $2,735 for ORLT. Hospital charges were significantly greater for ORIL and OR laser papilloma excision, and the charge for the surgeon was greater for ESIL than ORIL. Reimbursement was greater for OR laser papilloma excisions compared to those performed in the ES ($1,967 versus $2,964, respectively).
Laser excisions occur more frequently in the ES than in the OR. At every stage—preoperative, operative, and postoperative—ES procedures took significantly less time than OR cases. Assuming patients receive the same number of injection laryngoplasties, total costs to payer would be $2,265 in the ES and $2,942 in the OR. The study is biased by third-party payer reimbursement contracts that are specific to the study site.
Bottom line: For individual laryngology procedures, use of the ES reduces time and costs compared to the OR, increasing otolaryngologist and hospital efficiency.
Citation: Hillel AT, Oschner MC, Johns MM III, Klein AM. A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room. Laryngoscope. 2016;126:1385-1389.