title: Operating room versus office-based injection laryngoplasty: a comparative analysis of reimbursement.
abstract: BACKGROUND
  Injection laryngoplasty (IL) continues to evolve as new indications, techniques, approaches, and injection materials are developed. Although historically performed under local or general anesthesia in the operating room suite, IL is now increasingly being performed in an office-based setting. This report presents the results of a reimbursement analysis comparing office-based versus operative IL.
  
  
  OBJECTIVE
  The objective of this study was to compare the reimbursement of office-based injection laryngoplasty with the reimbursement of performing the same procedure in the operating room.
  
  
  METHODS
  The authors conducted reimbursement and outcome analysis through retrospective office chart and hospital record review.
  
  
  METHODS
  A retrospective review was performed of the hospital records of patients having undergone injection laryngoplasty at the University of Pittsburgh Voice Center from July 1998 through March 2005. Group I included patients who underwent IL in the operating room, whereas group II included those who had office-based IL. A reimbursement analysis for both groups was then performed comparing surgeon fees, anesthesia, and hospital charges and reimbursement. The clinical efficacy of IL performed in either office versus operating room settings was measured by comparing the pre- and postintervention Voice Handicap Index-10 scores for all patients. A predictive model of potential cost savings is developed based on the results of the analysis.
  
  
  RESULTS
  Average reimbursement was 2,505 dollars for group I (n = 108) and 496 dollars for group II (n = 50). This reimbursement differential was preserved across the various insurance types examined. There was no significant difference in Voice Handicap Index-10 change after surgery between group I and II.
  
  
  CONCLUSIONS
  Office-based IL is both clinically and financially effective, providing patients with a convenient and flexible alternative to operating room-based intervention for glottal insufficiency.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Michiel J
authors.initials: MJ
authors.lastname: Bové
authors.forename: Noel
authors.initials: N
authors.lastname: Jabbour
authors.forename: Priya
authors.initials: P
authors.lastname: Krishna
authors.forename: Kathi
authors.initials: K
authors.lastname: Flaherty
authors.forename: Melissa
authors.initials: M
authors.lastname: Saul
authors.forename: Robert
authors.initials: R
authors.lastname: Wunar
authors.forename: Clark A
authors.initials: CA
authors.lastname: Rosen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D000758:Anesthesia / Q000191:economics; D001284:Atrophy; D001672:Biocompatible Materials / Q000627:therapeutic use; D015331:Cohort Studies; D017046:Cost Savings; D005251:Fees, Medical; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000601:surgery*; D014827:Vocal Cords / Q000473:pathology / Q000601:surgery*; D014833:Voice Quality / Q000502:physiology
chemical_list: D001672:Biocompatible Materials