title: Prospective Analysis of Payment per Hour in Head and Neck Reconstruction: Fiscally Feasible or Futile?
abstract: BACKGROUND
  The authors assess the fiscal viability of complex head and neck reconstructive surgery by evaluating its financial reimbursement in the setting of resources used.
  
  
  METHODS
  The authors prospectively assessed provider reimbursement for consecutive patients undergoing head and neck reconstruction. Total care time was determined by adding 15 minutes to the operative time for each postoperative hospital day and each postoperative follow-up appointment within the 90-day global period. Physician reimbursement was divided by total care time hours to determine an hourly rate of reimbursement. A control group of patients undergoing carpal tunnel release was evaluated using the same methods described.
  
  
  RESULTS
  A total of 50 patients met the inclusion criteria for study. The payer was Medicaid for nine patients (18 percent), Medicare for 19 patients (38 percent), and commercial for 22 patients (44 percent). The average provider revenue per case was $3241.01 ± $2500.65. For all patients, the mean operative time was 10.6 ± 3.87 hours and the mean number of postoperative hospital days was 15.1 ± 8.06. The mean reimbursement per total care time hour was $254 ± $199.87. Statistical analysis demonstrated difference in reimbursement per total care time hour when grouped by insurance type (p = 0.002) or flap type (p = 0.033). Of the 50 most recent patients to undergo carpal tunnel release, the average revenue per case was $785.27.
  
  
  CONCLUSIONS
  Total care time analysis demonstrates that physician reimbursement is not commensurate with resources used for complex head and neck reconstructive surgery.
authors.affiliation: New York, N.Y. From the Division of Plastic and Reconstructive Surgery, Hofstra University School of Medicine, Northwell Health.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Chandler
authors.forename: Anthony
authors.initials: A
authors.lastname: Braswell
authors.forename: Denis
authors.initials: D
authors.lastname: Knobel
authors.forename: Brian T
authors.initials: BT
authors.lastname: Andrews
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bastidas
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.forename: Victor A
authors.initials: VA
authors.lastname: Moon
authors.forename: Armen K
authors.initials: AK
authors.lastname: Kasabian
authors.forename: Neil
authors.initials: N
authors.lastname: Tanna
mesh_terms: D000368:Aged; D001130:Arizona; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005245:Fee Schedules; D005260:Female; D006258:Head and Neck Neoplasms / Q000191:economics / Q000601:surgery*; D005102:Health Expenditures; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods; D014481:United States