Financial Impact of Medicare Payment Reform for E/M Visits on Compensation for Otolaryngologic Procedures in 2023.

Abstract

The Centers for Medicare & Medicaid Services (CMS) recently increased payment for 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. Using publicly available Medicare spending/utilization data, we estimated how much additional payment otolaryngologists would have received in 2023 if CMS had reimbursed global period visits at the same rates as other E/M visits. Our analysis included 291 procedures with 10- or 90-day global periods. The total estimated global period revenue loss was $7.0 M and concentrated among facial plastic/reconstructive ($3.3 M; 47.1%), head and neck ($1.5 M; 21.4%), and otologic ($1.2 M; 17.1%) procedures. Total estimated losses were greatest for nasal septoplasty (CPT 30520; $1.2 M), tympanostomy with ventilating tube placement (CPT 69433; $0.6 M), and cervical lymphadenectomy (CPT 38724; $0.5 M). Payment reforms based on robust and empirically-derived measures of physician work are necessary to promote fair procedural compensation.