ENT is an attractive specialty for ambulatory surgery centers because the procedures are generally short in length, use minimal supplies and have a quick recovery period. In the current and uncertain regulatory environment, ENT case reimbursement has remained relatively stable compared to other specialties. According to VMG Health's Multi-Specialty ASC Intellimarker 2011, the average net revenue for ENT cases in ASCs in 2010 was $2,009. The specialty accounted for 8 percent of all cases done in ASCs in 2010.
But the specialty is not without its challenges, and Jason Lockette, MD, an otolaryngologist in Florence, Ala., talks about two of the biggest issues facing ENT in the ASC setting in 2012.
1. An increase in physician employment threatens ASC ownership. Dr. Lockette points to a recent survey that found nearly one-third of residents were looking for employment. A survey a few years earlier found only 3-5 percent of residents were seeking employment.
"That specifically impacts us who have ownership in freestanding surgery centers," he says. "I hear from everybody that it was roughly a 10-fold increase. There's been a huge jump in the past 10 years since I've been out."
Dr. Lockette attributes much of that increase to the regulatory uncertainty regarding reimbursement rates, electronic medical record requirements and accountable care organizations.
"If you don't know what you're going to have to have, but you do know that it's going to be very expensive, it's not worth going in and spending that kind of money to start something," he says.
One of the major issues is the declining reimbursement rates, and Dr. Lockette compares them to a stock dropping in value.
"You don't value a stock very high when its dividends are decreasing," he says.
Starting a medical practice is very expensive, and Dr. Lockette says the cost and challenges of doing so are greater than they used to be. There's also a lot of bureaucratic issues that come along with a medical practice, and he doesn't see why physicians would shoulder that burden when they can outsource that to a hospital and make more money.
2. Expensive equipment is raising costs. Dr. Lockette says there are a lot of "expensive toys" in the ENT specialty now, and they don't all notably improve surgical outcomes or patient care.
"I try to keep up with the new technology," he says. "I've used them all. The data are not very convincing that there is any advantage in recovery or complication rates. It's costing a lot of money."
One such device is the plasma wand for performing tonsillectomy with plasma-mediated ablation. This method results in a cooler tissue ablation — often known by the brand name Coblation. A tonsillectomy is a bread-and-butter procedure for ENT. According to 2006 data from the U.S. Department of Health and Human Services, 877,000 tonsillectomies and/or adenoidectomies were done in an outpatient setting in 2006, making it the 9th most common outpatient procedure that year.
There is a growing debate about which tonsillectomy technique is the best. One technique is cooler tissue ablation using the plasma wand. The equipment for a traditional cold steel tonsillectomy costs less than $2, but a plasma wand will cost more than $100 for each procedure, Dr. Lockette says. The plasma wand was first introduced in 1998, and a 2006 survey of American Society of Pediatric Otolaryngologists members found that 16 percent use Coblation for tonsillectomy procedures.
For devices such as the plasma wand, Dr. Lockette believes there needs to be large, non-industry sponsored blinded trials to test the efficiency. Currently, no such studies exist, he says. One new technology that Dr. Lockette sees as essential is image-guided systems for sinus surgery, but the cost is still an issue.
"Image-guided systems are becoming more difficult to do without, and their cost is certainly not going down," he says.
Related Articles on ENT:
One-Sixth of Head and Neck Cancer Survivors Suffer From Chronic Pain
Olympus Announces Addition of Dissolvable Post-Sinus Surgery Products
Adding Endoscopic Balloon Sinoplasty to an ASC: 5 Thoughts From Neal Maerki
But the specialty is not without its challenges, and Jason Lockette, MD, an otolaryngologist in Florence, Ala., talks about two of the biggest issues facing ENT in the ASC setting in 2012.
1. An increase in physician employment threatens ASC ownership. Dr. Lockette points to a recent survey that found nearly one-third of residents were looking for employment. A survey a few years earlier found only 3-5 percent of residents were seeking employment.
"That specifically impacts us who have ownership in freestanding surgery centers," he says. "I hear from everybody that it was roughly a 10-fold increase. There's been a huge jump in the past 10 years since I've been out."
Dr. Lockette attributes much of that increase to the regulatory uncertainty regarding reimbursement rates, electronic medical record requirements and accountable care organizations.
"If you don't know what you're going to have to have, but you do know that it's going to be very expensive, it's not worth going in and spending that kind of money to start something," he says.
One of the major issues is the declining reimbursement rates, and Dr. Lockette compares them to a stock dropping in value.
"You don't value a stock very high when its dividends are decreasing," he says.
Starting a medical practice is very expensive, and Dr. Lockette says the cost and challenges of doing so are greater than they used to be. There's also a lot of bureaucratic issues that come along with a medical practice, and he doesn't see why physicians would shoulder that burden when they can outsource that to a hospital and make more money.
2. Expensive equipment is raising costs. Dr. Lockette says there are a lot of "expensive toys" in the ENT specialty now, and they don't all notably improve surgical outcomes or patient care.
"I try to keep up with the new technology," he says. "I've used them all. The data are not very convincing that there is any advantage in recovery or complication rates. It's costing a lot of money."
One such device is the plasma wand for performing tonsillectomy with plasma-mediated ablation. This method results in a cooler tissue ablation — often known by the brand name Coblation. A tonsillectomy is a bread-and-butter procedure for ENT. According to 2006 data from the U.S. Department of Health and Human Services, 877,000 tonsillectomies and/or adenoidectomies were done in an outpatient setting in 2006, making it the 9th most common outpatient procedure that year.
There is a growing debate about which tonsillectomy technique is the best. One technique is cooler tissue ablation using the plasma wand. The equipment for a traditional cold steel tonsillectomy costs less than $2, but a plasma wand will cost more than $100 for each procedure, Dr. Lockette says. The plasma wand was first introduced in 1998, and a 2006 survey of American Society of Pediatric Otolaryngologists members found that 16 percent use Coblation for tonsillectomy procedures.
For devices such as the plasma wand, Dr. Lockette believes there needs to be large, non-industry sponsored blinded trials to test the efficiency. Currently, no such studies exist, he says. One new technology that Dr. Lockette sees as essential is image-guided systems for sinus surgery, but the cost is still an issue.
"Image-guided systems are becoming more difficult to do without, and their cost is certainly not going down," he says.
Related Articles on ENT:
One-Sixth of Head and Neck Cancer Survivors Suffer From Chronic Pain
Olympus Announces Addition of Dissolvable Post-Sinus Surgery Products
Adding Endoscopic Balloon Sinoplasty to an ASC: 5 Thoughts From Neal Maerki