Are Office-Based Oral and Maxillofacial Surgical Procedures Profitable? A Benefit-Cost Analysis.

PURPOSE: Although many oral and maxillofacial surgical (OMS) procedures might seem to be profitable, no current data have analyzed the costs versus benefits of performing office-based OMS procedures. The purpose of the present study was to analyze the costs of performing 6 common office-based OMS procedures compared with the reimbursement rates for those same procedures. MATERIALS AND METHODS: The present study was a cross-sectional, microcosting survey analyzing the costs of materials used in the outpatient Oral-Maxillofacial Surgery clinic at the University of Texas Health Science Center at San Antonio. The costs incurred were based on dental procedure coding and national statistical databases and not on actual patient interactions. The primary predictor variable was the procedure costs for 6 commonly performed outpatient OMS procedures using 3 types of trays: a simple tray, a surgical tray, and an implant tray. The ancillary materials were listed for as-needed use for each tray. The primary outcome variable was the revenue after expenses per procedure. Descriptive statistics were computed. The net profit or net loss of performing 6 commonly performed outpatient OMS procedures was analyzed by subtracting the cost of performing the procedure from the insurance reimbursement for those procedures. RESULTS: Without the addition of sedation to the procedures, routine extractions had a net loss of $230 to $261, surgical extractions had a net loss of $153 to $242, and incision and drainage procedures had a net loss of $212 to $311. Furthermore, preprosthetic procedures had a net loss to net profit of -$269 to +$140, and pathologic procedures had a net loss to net profit of -$269 to +$326. Only implant procedures yielded a net profit of $847. CONCLUSIONS: The results of the present study have demonstrated that not all routine OMS procedures are profitable when performed alone without the inclusion of additional procedures or sedation.

Industry Payments in Oral and Maxillofacial Surgery: A Review of 112,448 Payments From a National Disclosure Program.

PURPOSE: The purpose of this study was to characterize the sources, amounts, and nature of general industry payments to oral and maxillofacial surgeons (OMSs). MATERIALS AND METHODS: The Open Payments database was searched from August 2013 to December 2017 for all general payments made to OMSs. For each payment, data were recorded regarding the date, value, paying organization, and nature of the payment. Analyses of variance were performed to compare payment amount per surgeon, number of payments per surgeon, and amount per payment across payment years. RESULTS: Overall, there were 112,448 payments totaling $28,644,063.20. Although, on average each year, 69% of OMSs received at least 1 payment, the top 10% of earners accounted for 89% ($25,607,781) of all payments. Each OMS received a median total of $93.75 (interquartile range, $33 to $263) and an average of $1,109.68 (SD, $14,297; range, $2-$2,250,345) per year. The mean payment value was $254.73 (SD, $2,727; range, $0.01-$548,126) compared with a median of $28.90 (interquartile range, $15-$82). Most payments were in the form of food and beverage (72%); however, the most dollars were spent on consulting fees ($5,594,087; 20%). From 2014 to 2016, significant decreases occurred in the payment amounts (P < .01) and number of payments (P < .01) per surgeon, as well as the value of each payment (P < .01). CONCLUSIONS: Although OMSs receive a substantial amount of industry payments, the overall figure is driven by a small percentage of top earners. Most individual payments were of nominal value, and their effect on clinical practice remains to be seen.

Shining Sunlight on Industry Payments in Oral and Maxillofacial Surgery: The Sunshine Act.

PURPOSE: To characterize industry payments to oral and maxillofacial surgeons (OMSs) and to determine the accuracy of the Centers for Medicare and Medicaid Services (CMS) Open Payments Databases. MATERIALS AND METHODS: This was a cross-sectional study of the CMS General and Research Payments Databases in 2016 for clinicians categorized as OMSs. General payments include consulting fees, honoraria, gifts, entertainment, food and beverage, travel and education, and others. Research payments include payments associated with research. Variables collected included number of OMSs who received payments, type of and number of payments, total amount paid, geographic distribution, and proportion of funding allotted to research. The accuracy of payee categorization was determined by verifying a random selection of 5% of those categorized as "OMS" in the database with publicly available data. To assess impact on research productivity, the h-index of research payment recipients was calculated. RESULTS: A total of 6,720 OMSs received industry compensation in 2016. Accuracy was 88% in the General Payments Database and 50% in the Research Payments Database. OMSs received 28,456 general payments totaling $5,971,800.79. The average number of payments and the average amount per payment were 4.27 and $1,597.60, respectively. The CMS reported total research payments of $23,592.17. The 4 verified OMSs received a total of $18,500 in research payments and had an average h-index of 3.25 (range, 0 to 8). The most common payments made were for food and beverage (80.2%), travel and lodging (5.83%), education (3.91%), compensation for services other than consulting (3.1%), and gifts (3.03%). Research accounted for 0.07% of all payments. CONCLUSION: Although industry payments to OMSs were common, research funding was negligible. Most industry value transfers were related to food and beverage or travel and lodging. Clinicians were accurately classified in the CMS General Payments Database but not in the Research Payments Database.

Medicare in Oral and Maxillofacial Surgery Part 2: Academic Surgeons and Cancer Surgeons Are Reimbursed Less.

PURPOSE: The purpose was to evaluate predictors of reimbursement of oral and maxillofacial surgery services in the Medicare population. MATERIALS AND METHODS: This was a cross-sectional study of Medicare Physician and Other Supplier Aggregate Data from 2015. Clinicians were included if they were confirmed to be oral and maxillofacial surgeons (OMSs) by National Provider Identifier data. The primary outcome variable of this study was the proportion reimbursed (actual payment amount divided by charge amount). Predictor variables included type of practice (private vs academic), scope (cancer vs non-cancer), number of Medicare beneficiaries seen, number of unique Current Procedural Terminology (CPT) codes billed, and total amount charged. Descriptive statistics and regression analyses were calculated, with P < .05 considered significant. RESULTS: The initial search revealed 952 providers categorized as performing maxillofacial surgery, with 894 confirmed to be OMSs (144 academic and 750 private practice). Of 894 OMSs, 39 were cancer surgeons and 855 were non-cancer surgeons. Academic OMSs saw more complex patients than OMSs in private practice (P < .0001). Academic surgeons (n = 144) charged an average of $116,876.92 to Medicare, with a mean payment amount of $22,219.62. Private practice surgeons (n = 750) submitted an average charge of $27,812.56, with average reimbursement of $9,472.76. Multiple linear regression showed that academia, cancer surgeons, number of unique CPT codes, higher Hierarchal Condition Category scores, and total submitted charge amount were negative predictors of the proportion of reimbursement. CONCLUSIONS: Roughly 10% of OMSs participate in and bill for Medicare. Factors associated with a lower reimbursement proportion include being in academia, treating head and neck cancer, billing more unique CPT codes, seeing sicker patients, and having larger total submitted charges. As third-party private insurers often follow fee schedules and rates set by the Centers for Medicare & Medicaid Services, this observed effect also should be evaluated in claims data of other insurers.

Conflicts of Interest in Clinical Guidelines: Lack of Authors and Disclosures in the AAOMS White Papers.

PURPOSE: The purpose of this study was to evaluate current state of authorship, financial disclosures, and conflicts of interest in position papers published by the American Association of Oral and Maxillofacial Surgeons (AAOMS). MATERIALS AND METHODS: This is a cross-sectional review of the position papers published by the AAOMS from 2013 to 2017. Primary outcome variables include position papers published by the AAOMS. Secondary outcome variables include declaration of authorship, financial disclosures, and financial payments. The Open Payments Database for financial disclosures was reviewed for the year the position paper was published and the immediate preceding year. RESULTS: Ten position papers were published by the AAOMS from 2013 to 2017. Of the 10 papers, authorship was listed in 3, and none explicitly addressed the presence or absence of financial disclosures or conflicts of interest. Contributors to 3 of the 3 authored papers were found at review of the Open Payments Database to have received industry funding in the year the position paper was published and the immediate preceding year. The remuneration ranged from less than $1,000 to $554,006.02. CONCLUSION: Position papers published by the AAOMS lack standardization for authorship and statements on potential financial disclosure. The authors suggest full disclosures of authorship and authors' conflicts of interest should be stated on all position papers to provide transparency to the process.

An investigation into the variability of primary care oral surgery contracts and tariffs in England and Wales (2014/2015).

Primary care oral surgery services vary markedly throughout the country but until now there has been a paucity of data on these services. The British Association of Oral Surgeons (BAOS) primary care group (the authors) were tasked to gather data around primary care oral surgery contracts and tariffs and provide evidence-based recommendations on the commissioning of these services. Following a freedom of information (FOI) request, data were obtained for 27 English local area teams and seven Welsh local health boards. The data demonstrated both regional and national variability with respect to primary care oral surgery contracts, concerning both contract type and level of remuneration. These differences are discussed and the authors make recommendations for standardising oral surgery contracts and tariffs.

Is Treating Oral and Maxillofacial Trauma Profitable? An Analysis of Hospital and Surgeon Reimbursement at an Academic Medical Center.

PURPOSE: During the past 2 decades, there has been a marked decrease in the willingness of community-based oral and maxillofacial surgeons to participate in trauma call. Although many factors can influence the decision not to take trauma call, 1 primary disincentive is the perception that managing facial trauma might be profitable for the hospital, but not profitable for the surgeon. The purpose of this study was to compare the profitability of facial trauma management for the hospital and the surgeon at the Virginia Commonwealth University (VCU) Medical Center (Richmond, VA). MATERIALS AND METHODS: In this retrospective cohort study, records were collected for patients who were seen for primary trauma management by the Department of Oral and Maxillofacial Surgery at VCU (VCUOMS) from June 2011 through July 2014. Cost and reimbursement data were analyzed for these patients from the VCU Health System (VCUHS) and the VCUOMS. For the hospital, actual cost data were provided; for the surgeon, cost was calculated based on an average overhead of 50%. For uniformity, patients were excluded if they remained in the hospital for longer than a 23-hour observation period. Patients younger than 18 years also were excluded. RESULTS: In total, 169 patients met the inclusion criteria. There was a statistically relevant difference in the percentage of costs recouped and the actual profit. The average percentage of costs recouped was 230% for the VCUHS versus 47% for the VCUOMS. This amounts to an average profit per case of $3,461 for the hospital versus a loss of $1,162 for the surgeon. CONCLUSIONS: The results of this study indicate that in the VCU Medical Center, maxillofacial trauma yields a net profit for the hospital and a net loss for the operating surgeon. Although the results are limited to outpatient management at 1 academic institution, they suggest that hospitals in some settings might be in a position to incentivize surgeons for trauma management.

An Investigation Into the Disease Profile and Healthcare Costs of Inpatients Treated at a Major Oral and Maxillofacial Surgical Center.

OBJECTIVE: This study is a retrospective review which reported on the treatment records of oral and maxillofacial inpatients treated at a medical institution with the largest scale of oral and maxillofacial specialist services in China, to reflect on disease profile, healthcare model characteristics and the medical status of oral and maxillofacial surgery in China. PATIENTS AND METHODS: Information on 25,825 patients hospitalized between 2008 and 2013 was collected to analyze the mean length of stay (LOS) and preoperative LOS, expenditure patterns, and payment status. RESULTS: The overall mean LOS and preoperative LOS were 10.0 ±â€Š4.9 days and 4.3 ±â€Š2.1 days, respectively. The main costs composed of surgery charges and material costs (47.4%). The proportion of nonlocal patients was 76.34% and the majority of patients used their basic medical insurance (57.74%), and the proportion of patients self-paying showed the largest increase over time. Rising charges for inpatients in this institution did not cause an aggravation of medical cost burden of residents. Cost burden of oral and maxillofacial malignancy surgery patients was higher than in developed countries. CONCLUSIONS: The overall mean LOS and preoperative LOS were higher than that of similar patients globally. Compared with medicine and material costs, medical income is lower and the value of medical personnel labor is not fully appreciated. The proportion of patients who actually enjoy the benefits of the basic medical insurance in China is lower than the coverage.

Surgeon Reimbursements in Maxillofacial Trauma Surgery: Effect of the Affordable Care Act in Ohio.

BACKGROUND: Surgical treatment of maxillofacial injuries has historically been associated with low reimbursements, mainly because of the high proportion of uninsured patients. The Affordable Care Act, implemented in January of 2014, aimed to reduce the number of uninsured. If the Affordable Care Act achieves this goal, surgeons may benefit from improved reimbursement rates. The authors' purpose was to evaluate the effects of the Affordable Care Act on payor distribution and surgeon reimbursements for maxillofacial trauma surgery at their institution. METHODS: A review of all patients undergoing surgery for maxillofacial trauma between January of 2012 and December of 2014 was conducted. Insurance status, and amounts billed and collected by the surgeon, were recorded. Patients treated before implementation of the Affordable Care Act were compared to those treated after. RESULTS: Five hundred twenty-three patients were analyzed. Three hundred thirty-four underwent surgery before implementation of the Affordable Care Act, and 189 patients underwent surgery after. After implementation of the Affordable Care Act, the proportion of uninsured decreased (27.2 percent to 11.1 percent; p < 0.001) and the proportion of patients on Medicaid increased (7.8 percent to 25.4 percent; p < 0.001). Overall surgeon reimbursement rate increased from 14.3 percent to 19.8 percent (p < 0.001). CONCLUSIONS: After implementation of the Affordable Care Act, we observed a significant reduction in the proportion of maxillofacial trauma patients who were uninsured. Surgeons' overall reimbursement rate increased. These trends should be followed over a longer term to determine the full effect of the Affordable Care Act.

Association between funding, risk of bias, and outcome of randomised controlled trials in oral and maxillofacial surgery.

The influence of funding on the main outcome of a random control trial (RCT) is important, as it could potentially lead to bias towards industry, and results that are too optimistic. We investigated the association between funding, the published outcome, and the risk of bias in trials in oral and maxillofacial surgery (OMFS) published from January 2000 to May 2013 listed in PubMed. The methods used were scored using the risk of bias items given in a Delphi List. Sources of funding were recorded and categorised five ways: not funded, funded by industry, not funded by industry, supported by industry, and source of funds not clear. A total of 390 RCT met the inclusion criteria, and there was a correlation between funding and favourable main outcomes, although this was not significant. There was no correlation between the risk of bias and favourable results of the main outcome of a trial, or between the risk of bias and the reported source of funding in post-hoc analysis. We were unable to show a significant correlation between funding and a higher likelihood of a favourable result for the primary outcome in RCT in OMFS. We also failed to show a significant correlation between the risk of bias of a trial and its main outcome. In contrast, the source of funding proved to affect the risk of bias of a trial significantly, although not in post-hoc analysis. Funded trials were better organised, and so had a lower risk of bias.

Oral and Maxillofacial Surgery Foundation Research and Fellowship Awards: A 26-Year Review at Massachusetts General Hospital and Harvard School of Dental Medicine.

PURPOSE: The purpose of this study was to review outcomes of the Oral and Maxillofacial Surgery (OMS) Foundation's funding awards to members of the OMS department at Massachusetts General Hospital (MGH) in terms of projects completed, abstracts presented, peer-reviewed publications, and career trajectories of recipients. MATERIALS AND METHODS: Data were collected from MGH and OMS Foundation records and interviews with award recipients. Primary outcome variables included 1) number of awards and award types, 2) funding amount, 3) project completion, 4) number of presented abstracts, 5) conversion from abstracts to publications, 6) number of peer-reviewed publications, 7) career trajectories of awardees, and 8) additional extramural funding. RESULTS: Eleven Student Research Training Awards provided $135,000 for 39 projects conducted by 37 students. Of these, 34 (87.2%) were completed. There were 30 student abstracts presented, 21 peer-reviewed publications, and a publication conversion rate of 58.8%. Faculty research awards comprised $1,510,970 for 22 research projects by 12 faculty members and two research fellows. Of the 22 funded projects, 21 (95.5%) were completed. There were 110 faculty and research fellow abstracts presented and 113 peer-reviewed publications, for a publication conversion rate of 93.8%. In the student group, 17 of 37 (45.9%) are enrolled in or are applying for OMS residencies. Of the 10 students who have completed OMS training, 3 (30%) are in full-time academic positions. Of the 12 faculty recipients, 9 (75%) remain in OMS academic practice. During this time period, the department received $9.9 million of extramural foundation or National Institutes of Health funding directly or indirectly related to the OMS Foundation grants. CONCLUSIONS: The results of this study indicate that 90.2% of projects funded by the OMS Foundation have been completed. Most projects resulted in abstracts and publications in peer-reviewed journals. These grants encouraged students to pursue OMS careers and aided OMS faculty in developing their research programs.

Do the Science, Own the Field. Are We Doing the Science?

For oral and maxillofacial surgery to continue being a premier specialty in the management of patients with craniomaxillofacial conditions, contributions to the better treatment of these patients must be continuously offered. Without performing the science, these offerings will not come or will not be valid. Environmental and funding challenges to performing the science have increased in the past 2 decades. The incorporation of protected research time and a research sabbatical for residents within their training program might be effective ways to meet these challenges.