Abstract
Objectives:
(1) Determine if there is significant geographic variation in surgical charges for endoscopic sinus surgery (ESS) across states. (2) Understand factors that influence charges.
Methods:
The State Ambulatory Surgery Databases (2010) for Florida, Iowa, New York, and North Carolina were analyzed, extracting cases of adult endoscopic sinus surgery. Demographic, diagnostic, procedural, insurance, and charge data were tabulated. Extent of surgery was quantified by number of sinusotomies and other nasal procedures (eg, septoplasty) performed. Variation in state-to-state total charges for ESS was determined adjusting for demographic and procedural parameters.
Results:
A total of 22,350 ambulatory ESS cases were examined across 4 states (mean age, 48.5 years; 51.6% female). Private insurance and Medicare were the primary payers in 69.5% and 19.3% of cases, respectively. Image guidance was utilized in 21.0% and polyps were present in 26.8% of cases. There was wide variation in the distribution of sinusotomies per case performed: Florida had the highest percentage of 5 sinusotomy cases (18.8%) versus 15.9% for New York and only 7.0% for Iowa (P < .001). Adjusting for image guidance, polyposis, other nasal surgery, number of sinusotomies, and payer and median household income, there was a significant difference in mean total charges for ESS by state: Florida ($22,403), Iowa ($17,574), North Carolina ($14,650), and New York ($12,641; P < .001 analysis of variance).
Conclusions:
Considerable state-to-state variation in charges for ambulatory ESS exists. These data will become increasingly important as mandates for charge and cost transparency for the healthcare consumer manifest nationally. Efforts to determine reasons for these cost variances should be undertaken.
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