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Provider Reimbursement and Total Care Time Resource Utilization in Complex Head & Neck Reconstructive Surgery: Financially Feasible or Futile?
Benjamin D. Smith, B.S., Anthony Braswell, M.D., Denis Knobel, M.D., Brian T. Andrews, M.D., Nicholas Bastidas, M.D., Armen K. Kasabian, M.D., Neil Tanna, M.D., M.B.A..
North Shore - LIJ Health System, New York, NY, USA.

PURPOSE:
The authors assess the fiscal viability of complex head and neck reconstructive surgery by evaluating its financial reimbursement in the setting of utilized resources.
METHODS:
The authors prospectively assessed provider reimbursement for consecutive patients undergoing head and neck free flap (FF) or pedicled flap (PF) reconstructive surgery. Total care time (TCT) was determined by adding 15 minutes to the operative time for each post-operative hospital day and each post-operative follow-up appointment within the 90 day global period. Physician reimbursement was divided by TCT hours to determine an hourly rate of reimbursement.
RESULTS:
A total of 50 patients met the inclusion criteria for study. The payer was Medicaid or Managed Medicaid for 9 patients (18%), Medicare for 19 (38%), and Commercial for 22 (44%). The majority of patients received a free flap (64%). The average provider revenue per case was $3241.01. For the all patients, mean operative time was 10.6 hours and mean post-operative hospital days were 15.1. The mean reimbursement per TCT hour was $254. By payer type, the mean revenue per TCT hour was $153 for Medicaid, $174 for Medicare, and $367 for Commercial. When grouped by type of flap, pedicled flaps were reimbursed at a rate of $179 and free flaps at $299 per TCT hour. Statistical analysis demonstrated difference in reimbursement per TCT hour when grouped by insurance type (p=0.001) or flap type (p=0.045).
CONCLUSION:
TCT analysis demonstrates that physician reimbursement is not commensurate with resources utilized for complex head and neck reconstructive surgery.


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