Trends in sleep studies performed for Medicare beneficiaries.

OBJECTIVES/HYPOTHESIS: To quantify trends and characteristics of sleep studies performed for Medicare beneficiaries in the United States. STUDY DESIGN: Retrospective longitudinal study of the Centers for Medicare and Medicaid Services' Part B National Summary Data and Medicare Provider Utilization and Payment Data from 2000 to 2014. METHODS: Sleep study data were analyzed according to type of study performed, total expenditure amount, provider specialty, and geographic location. RESULTS: In 2014, 845,569 sleep studies were completed by 1.4% of Medicare beneficiaries for a total of $189 million. Since 2010, annual expenditures for sleep studies have declined, whereas the number of studies performed has increased by 9.1%. In 2014, polysomnography, split-night polysomnography, and unattended home sleep studies accounted for 40%, 48%, and 12%, respectively, of total sleep studies. This represents a dramatic growth in the number of unattended sleep studies performed since 2000, when they represented only 0.9%. Pulmonologists, independent diagnostic testing facilities, and neurologists are the top specialties that bill for sleep studies. Sleep medicine is a growing specialty and ranked fifth among providers, whereas otolaryngologists ranked eighth. CONCLUSIONS: The healthcare burden of administering sleep studies is substantial, although the annual cost is declining. Unattended sleep studies contribute to decreasing costs and should be considered for patients who meet the correct indications. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2891-2896, 2017.

Economic and Demographic Characteristics of Cerumen Extraction Claims to Medicare.

IMPORTANCE: Cerumen extractions are performed in a large portion of otolaryngology and head and neck surgery practices. The burden on the health care system of cerumen extractions is unknown and demographics have not been characterized at a population level. OBJECTIVE: To quantify the cost burden and health care burden of cerumen extraction among Medicare recipients in the United States. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cross-sectional study was conducted of all cerumen disimpactions documented in the Centers for Medicare & Medicaid Services Provider Utilization and Payment database from January 1 to December 31, 2012. Data analysis was conducted from August 4, 2014, to July 24, 2015. EXPOSURE: Cerumen disimpaction. MAIN OUTCOMES AND MEASURES: Cerumen extractions were analyzed by state, medical or surgical specialty, reimbursement, and type of health care professional performing the extraction. RESULTS: The Centers for Medicare & Medicaid Services reimbursed $46.8 million for 1.3 million cerumen disimpactions in 2012 (mean, $35.38 per procedure). The mean reimbursement rate per cerumen disimpaction varied by state from $25.41 in Puerto Rico to to $40.24 in New Jersey. The percentage of Medicare beneficiaries receiving cerumen extractions per state ranged from 0.55% in Puerto Rico to 4.92% in New Jersey. California had the overall highest total number of cerumen disimpactions (n = 132 823). The majority of cerumen extractions were performed by otolaryngology-head and neck practitioners (67.60%), although internal medicine (32.66%) and family practice (33.87%) had a higher amount of practitioners performing the procedure. The majority of cerumen extractions are performed by physicians (90.53%). CONCLUSIONS AND RELEVANCE: Cerumen extraction is one of the most common procedures performed by otolaryngology health care professionals. Practice patterns and reimbursement rates vary greatly across the country.