TY - JOUR
T1 - National Geographical Variation in Sinus Balloon Dilation
AU - Gadkaree, Shekhar K.
AU - Rathi, Vinay K.
AU - Feng, Allen L.
AU - Workman, Alan D.
AU - Phillips, Katie M.
AU - Barbarite, Eric
AU - Bergmark, Regan W.
AU - Scangas, George A.
AU - Metson, Ralph
N1 - Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2020.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - Objective: The primary aim of this study was to describe national variations in sinus balloon dilation (SBD), examine the relationship between endoscopic sinus surgery (ESS) and SBD prevalence patterns, and evaluate associations between reimbursement rates and regional variations in sinus surgery. Study Design: Retrospective observational study. Setting: Medicare Provider Utilization and Payment (PUP) Part B Data from January 1, 2016, to December 31, 2016. Subjects and Methods: Physicians in the PUP Part B Database Performing ESS or SBD in 2016. States were stratified into average- or high-volume utilizers based on the number of ESS procedures and SBD procedures per population and compared. Results: Eight states were classified as high-volume utilizers of SBD—Florida, Kansas, Louisiana, Mississippi, Nevada, New Mexico, South Dakota, and Texas. Only 3 of these states—Kansas, Mississippi, and Nevada—were classified as high-volume utilizers of ESS. Reimbursement rates were significantly higher for SBD as compared to ESS ($1538 [interquartile range (IQR), 1473-1664] vs $335 [IQR, 261-412] per procedure, P <.001). High-volume utilizer SBD states had a higher number of otolaryngologists (13.0 [IQR, 7-16] vs 6.0 [IQR, 2-3]) otolaryngologists per state (P <.001) and a trend toward an increased rate of performing ESS procedures (19 [IQR, 19-41] vs 6.0 [IQR, 2-32], P =.034) procedures per million residents) than average-volume utilizer SBD states. Conclusions: The southern United States has a significantly higher rate of SBD procedures performed compared to the rest of the country, but these rates do not appear to be directly related to statewide variations in SBD reimbursement.
AB - Objective: The primary aim of this study was to describe national variations in sinus balloon dilation (SBD), examine the relationship between endoscopic sinus surgery (ESS) and SBD prevalence patterns, and evaluate associations between reimbursement rates and regional variations in sinus surgery. Study Design: Retrospective observational study. Setting: Medicare Provider Utilization and Payment (PUP) Part B Data from January 1, 2016, to December 31, 2016. Subjects and Methods: Physicians in the PUP Part B Database Performing ESS or SBD in 2016. States were stratified into average- or high-volume utilizers based on the number of ESS procedures and SBD procedures per population and compared. Results: Eight states were classified as high-volume utilizers of SBD—Florida, Kansas, Louisiana, Mississippi, Nevada, New Mexico, South Dakota, and Texas. Only 3 of these states—Kansas, Mississippi, and Nevada—were classified as high-volume utilizers of ESS. Reimbursement rates were significantly higher for SBD as compared to ESS ($1538 [interquartile range (IQR), 1473-1664] vs $335 [IQR, 261-412] per procedure, P <.001). High-volume utilizer SBD states had a higher number of otolaryngologists (13.0 [IQR, 7-16] vs 6.0 [IQR, 2-3]) otolaryngologists per state (P <.001) and a trend toward an increased rate of performing ESS procedures (19 [IQR, 19-41] vs 6.0 [IQR, 2-32], P =.034) procedures per million residents) than average-volume utilizer SBD states. Conclusions: The southern United States has a significantly higher rate of SBD procedures performed compared to the rest of the country, but these rates do not appear to be directly related to statewide variations in SBD reimbursement.
KW - balloon dilation
KW - endoscopic sinus surgery
KW - geographical variation
KW - procedural trends
KW - sinus balloon dilation
UR - http://www.scopus.com/inward/record.url?scp=85081983147&partnerID=8YFLogxK
U2 - 10.1177/0194599820908217
DO - 10.1177/0194599820908217
M3 - Article
C2 - 32122235
AN - SCOPUS:85081983147
SN - 0194-5998
VL - 162
SP - 761
EP - 766
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 5
ER -