Office-Based Laser Surgery of the Larynx: A Cost Analysis

Abstract

Objective: While office based laser surgery (OBLS) for benign laryngeal disease is cost-effective for the patient, the financial impact on the office offering the service has not been characterized. We hypothesize that OBLS offers a savings to the patient which is not widely realized because the technology poses a financial liability.

Method: A 2-part cost analysis study was performed. First, cost and reimbursements for 50 patients undergoing OBLS was compared with 50 patients undergoing operative direct laryngoscopy with laser (DLL). Second, detailed financial comparison was done on a self-paired series of patients who had each undergone both OBLS and DLL.

Results: When compared with DLL, there was over $5,000.00 per case cost savings to the patient/third party payer for OBLS. Mean total reimbursement per DLL was $6,453.44, including hospital, anesthesiologist, and surgeon reimbursements of $5,150.00, $745.66, and $357.78, respectively. Based on a mean hospital DLL cost of $2,069.15, the hospital profited over $3000 per case. For OBLS in a nonfacility office setting, mean total reimbursement was $643.08 with mean procedure and laser fiber reimbursements of $596.52 and $46.56, respectively. Based on mean office expenses of $1,388.06 for equipment expenses and nursing staff, the office lost over $500 per OBLS case.

Conclusion: OBLS offers health care cost savings that are not widely realized because of the financial loss incurred by the office. An ideal reimbursement model is proposed that would cover the cost of OBLS, and could lead to nearly $400 million in health care costs savings annually.