Airway stenting: Applications and practice management considerations

Area of Science:

• Pulmonary Medicine
• Interventional Pulmonology
• Healthcare Management

Background:

• Airway stenting procedures are increasingly common, facilitated by metallic stents and flexible bronchoscopy.
• These interventions necessitate specific physician skill sets and impact practice management strategies.
• Central airway stenting involves combined therapies and technical considerations relevant to practice management.

Purpose of the Study:

• To analyze reimbursement scenarios for airway stent placement.
• To compare reimbursement for airway stenting with other pulmonary and critical care physician activities.
• To evaluate facility payments for procedures involving silicone and metallic stents.

Main Methods:

• Comparison of reimbursement scenarios using Medicare relative value units (RVUs) and average reimbursement amounts.
• Analysis of professional and facility reimbursement for stent placement.
• Evaluation of Medicare outpatient and inpatient payments for silicone and metallic stent procedures.

Main Results:

• Professional reimbursement is consistent across stent types, insertion methods, and anesthesia.
• Net facility reimbursement is significantly influenced by stent costs.
• RVUs alone are insufficient for comparing therapeutic bronchoscopy reimbursement due to coding edits.
• Professional fees for advanced therapeutic bronchoscopy are not competitive when considering procedure time.
• Net facility reimbursement is primarily determined by stent costs.

Conclusions:

• Airway stent placement is reimbursed at non-competitive rates, potentially resulting in facility financial losses.
• Effective practice management for central airway therapy is best achieved through a multidisciplinary team approach.
• Establishing a dedicated cost center structure is recommended for managing central airway therapy services.