Office-Based Laser Surgery of the Larynx

Abstract

Objective. While office-based laser surgery (OBLS) for benign laryngeal disease is cost-effective for the patient, the financial impact on the office offering the service has not been characterized. We hypothesize that OBLS offers savings to the patient that are not widely realized because of the financial liability the technology poses. Study Design. A 2-part financial analysis. Setting. (1) Hospital operating room and (2) non–facility-based office. Subjects and Methods. First, the average cost and reimbursements for 50 patients undergoing OBLS were compared with those of 50 patients undergoing operative direct laryngoscopy with laser (DLL). Second, a detailed financial comparison was performed on a self-paired series of patients who had each undergone both OBLS and DLL for benign laryngeal disease. Results. When compared with DLL, OBLS provides more than a $5000 per-case cost savings for the third-party payer. Average DLL reimbursement was $6453.44 per case, including hospital, anesthesiologist, and surgeon reimbursements of $5150, $745.66, and $357.78, respectively. Based on the calculated hospital cost of $2069.15 per case, the hospital profited more than $3000 per DLL. For OBLS in a non–facility office setting, the average reimbursement was $643.08 per case, with procedure and laser fiber reimbursements of $596.52 and $46.56, respectively. Based on office expenditures of $1388.06 per case, the office lost more than $500 per OBLS case. Conclusion. OBLS in a non–facility-based office setting leads to a net financial loss for the office, making OBLS-associated health care cost savings unlikely to be widely realized unless reimbursement patterns are changed.