Cost analysis of office-based and operating room procedures in rhinology

Analyses of office-based procedures in laryngology and otology have shown them to be safe and satisfying for patients, with substantial savings of time and money for patients and physicians. The objectives of this study were to compare the billable charges and reimbursement for rhinologic procedures performed in the office with charges for procedures performed in an ambulatory surgery center operating room (OR).

A retrospective, matched-pair cost analysis was performed. Patients who underwent office-based procedures between 2006 and 2011 were matched by Current Procedural Terminology® (CPT) code with patients who underwent similar procedures in the OR. Twenty-nine matched pairs were included. Charges for surgery, anesthesia, and facility usage were analyzed. Because surgery charges may be influenced by contracts with insurance providers, both the total billed charges and total allowed charges were analyzed using paired t tests. When a single office-based procedure was compared with multiple procedures performed during the same operation in the OR, anesthesia and facility charges were scaled to allow for more accurate comparison.

Mean total charges for office-based procedures were significantly less than for OR procedures ($2,737.17 vs $7,329.69, p < 0.001). Mean allowed charges for office-based procedures were significantly less than for OR procedures ($762.08 vs $5,835.09, p < 0.001). Mean scaled charges for office-based procedures were also significantly less than mean scaled charges for OR procedures ($762.08 vs $4,089.33, p < 0.001). Office procedures were reimbursed at similar or higher rates than were OR procedures.

In appropriate patients, performing simple rhinologic procedures in the office rather than in the OR offers significant cost savings without impacting physician reimbursement.