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Cost Analysis of Ultrasound in Head and Neck Practices
Otolaryngology– Head and Neck Surgery Volume 133 Number 2
11:36
AM
Electrical Stimulation of Post-Irradiated Head and Neck SCCA Chad M McDuffie, MD (presenter); Matt Morgan; Cynthia Armstrong; Cherie Ann O Nathan, MD Shreveport LA; Shreveport LA; Shreveport LA; Shreveport LA
Objective: We noted a significant improvement in complaints of dysphagia in patients with head and neck cancer who had received noninvasive neuromuscular electrical stimulation (E-stim) of their pharyngeal muscles. We wanted to determine if the improvement in dysphagia was associated with decreased complaints of xerostomia, as one of the first patients being treated with E-stim noticed a significant improvement in xerostomia. Methods: Study Design: Retrospective review of dysphagia questionnaires instituted by our speech pathologists on head and neck cancer patients that had received radiotherapy and had undergone E-stim for dysphagia. Methods: Prior to the initiation of E-stim and 1 to 2 months after E-stim, patients were asked to answer a Dysphagia and Xerostomia Index questionnaire. All patients received E-stim 2-4 months after completing XRT. Patients received three E-stim treatments per week for a total of 1-2 months. Four electrodes placed along anterior neck over pharyngeal muscles. E-stim was initiated using 4 to 30mA at 80 to 100 pulse-widths. Results: Results: 12 patients that received either postoperative radiation therapy or concomitant chemoradiotherapy had been treated with E-stim. All 12 patients noticed a significant improvement in dysphagia. 8/12 patients noticed a definite increase in saliva production with symptoms of less intake of water with meals, sleeping longer hours at night, and increased moistness of lips.
Conclusion: Conclusions: E-stim therapy appears to be an effective and approved treatment for dysphagia. Our study shows that it may also be an alternative treatment for xerostomia in the post-irradiated head and neck cancer patients. Significance: To determine if E-stim will benefit the postirradiated patient with swallowing and xerostomia.
11:44
AM
Cost Analysis of Ultrasound in Head and Neck Practices Nadeem A. Akbar (presenter); Don Bodenner, MD PhD; Lawrence Kim, MD; James Y Suen, MD; Mimi S Kokoska, MD Little Rock AR; Little Rock AR; Little Rock AR; Little Rock AR; Little Rock AR
Objective: Evaluation of subclinical lymphadenopathy or masses in the head and neck generally require an imaging study. Ultrasound (US) provides real time, non-invasive imaging information. Cellular specimens can be readily obtained by ultrasound guided fine needle aspiration (USGFNA) thereby avoiding more expensive imaging modalities or open biopsies. USGFNA has 95.7% sensitivity and 92.9% specificity for differentiation between benign and metastatic nodes. We have incorporated office based ultrasound (OBUS) in our clinical practice. The purpose of this study is to determine the cost considerations and strategies for incorporating ultrasound in head and neck practices. Methods: A retrospective review of OBUS related charts and billing trends (1999-2004) at our academic medical center was completed. The billing parameters, Medicare billing values for US and USGFN A were examined, in addition to the general costs of various US machines. These data were used to estimate the cost effectiveness of US in an academic practice. Results: Different CPT codes were submitted by two physicians for the same US related procedure. The relative reimbursements for these CPT codes were compared. Specific codes should be used to avoid bundling. Cost sharing is an effective strategy to offset the expenditure of US in a multidisciplinary or academic practice. US systems range from $30,000 to $200,000. Target case volumes are necessary to offset the expenditure of US systems. Conclusion: Based on a practice’s volume, specific CPT codes and Medicare reimbursements, a low end US could be offset in one year and a high end US from 2 to 3 years. Significance: US can be readily incorporated into the office. The projected usage volume which is necessary to offset upfront equipment costs of OBUS is provided. There are billing and usage strategies that we have identified which improve the economics of providing office based US and USGFNA.
TUESDAY
for seven days starting on the first postoperative day. Patients were assessed with anthropometric, biochemical indices and immunologic tests (number of leucocytes, lymphocytes, CD4⫹, CD8⫹, HLA–DR, CRP, IL6, IL1,serum immunoglobulin levels). Results: A major difference was found in postoperative complications between the two groups.Complication rate in group A was 7,1% and in group B was 57%. The difference was statistically significant (p ⫽ 0,01). Mortality was 7,1% in group B. Conclusion: Perioperative enteral immunonutrition seems to lead to fewer surgical complications in patients undergoing major head and neck surgery irrespective their nutritional status, therefore wider use of perioperative enteral immunonutrition should be considered. Significance: This is the first study looking at the use of perioperative enteral immunonutrition in patients undergoing major head and neck surgery with considerable impact on the final outcome.
Research Forum—Tuesday P101
11:36
AM
Electrical Stimulation of Post-Irradiated Head and Neck SCCA Chad M McDuffie, MD (presenter); Matt Morgan; Cynthia Armstrong; Cherie Ann O Nathan, MD Shreveport LA; Shreveport LA; Shreveport LA; Shreveport LA
Objective: We noted a significant improvement in complaints of dysphagia in patients with head and neck cancer who had received noninvasive neuromuscular electrical stimulation (E-stim) of their pharyngeal muscles. We wanted to determine if the improvement in dysphagia was associated with decreased complaints of xerostomia, as one of the first patients being treated with E-stim noticed a significant improvement in xerostomia. Methods: Study Design: Retrospective review of dysphagia questionnaires instituted by our speech pathologists on head and neck cancer patients that had received radiotherapy and had undergone E-stim for dysphagia. Methods: Prior to the initiation of E-stim and 1 to 2 months after E-stim, patients were asked to answer a Dysphagia and Xerostomia Index questionnaire. All patients received E-stim 2-4 months after completing XRT. Patients received three E-stim treatments per week for a total of 1-2 months. Four electrodes placed along anterior neck over pharyngeal muscles. E-stim was initiated using 4 to 30mA at 80 to 100 pulse-widths. Results: Results: 12 patients that received either postoperative radiation therapy or concomitant chemoradiotherapy had been treated with E-stim. All 12 patients noticed a significant improvement in dysphagia. 8/12 patients noticed a definite increase in saliva production with symptoms of less intake of water with meals, sleeping longer hours at night, and increased moistness of lips.
Conclusion: Conclusions: E-stim therapy appears to be an effective and approved treatment for dysphagia. Our study shows that it may also be an alternative treatment for xerostomia in the post-irradiated head and neck cancer patients. Significance: To determine if E-stim will benefit the postirradiated patient with swallowing and xerostomia.
11:44
AM
Cost Analysis of Ultrasound in Head and Neck Practices Nadeem A. Akbar (presenter); Don Bodenner, MD PhD; Lawrence Kim, MD; James Y Suen, MD; Mimi S Kokoska, MD Little Rock AR; Little Rock AR; Little Rock AR; Little Rock AR; Little Rock AR
Objective: Evaluation of subclinical lymphadenopathy or masses in the head and neck generally require an imaging study. Ultrasound (US) provides real time, non-invasive imaging information. Cellular specimens can be readily obtained by ultrasound guided fine needle aspiration (USGFNA) thereby avoiding more expensive imaging modalities or open biopsies. USGFNA has 95.7% sensitivity and 92.9% specificity for differentiation between benign and metastatic nodes. We have incorporated office based ultrasound (OBUS) in our clinical practice. The purpose of this study is to determine the cost considerations and strategies for incorporating ultrasound in head and neck practices. Methods: A retrospective review of OBUS related charts and billing trends (1999-2004) at our academic medical center was completed. The billing parameters, Medicare billing values for US and USGFN A were examined, in addition to the general costs of various US machines. These data were used to estimate the cost effectiveness of US in an academic practice. Results: Different CPT codes were submitted by two physicians for the same US related procedure. The relative reimbursements for these CPT codes were compared. Specific codes should be used to avoid bundling. Cost sharing is an effective strategy to offset the expenditure of US in a multidisciplinary or academic practice. US systems range from $30,000 to $200,000. Target case volumes are necessary to offset the expenditure of US systems. Conclusion: Based on a practice’s volume, specific CPT codes and Medicare reimbursements, a low end US could be offset in one year and a high end US from 2 to 3 years. Significance: US can be readily incorporated into the office. The projected usage volume which is necessary to offset upfront equipment costs of OBUS is provided. There are billing and usage strategies that we have identified which improve the economics of providing office based US and USGFNA.
TUESDAY
for seven days starting on the first postoperative day. Patients were assessed with anthropometric, biochemical indices and immunologic tests (number of leucocytes, lymphocytes, CD4⫹, CD8⫹, HLA–DR, CRP, IL6, IL1,serum immunoglobulin levels). Results: A major difference was found in postoperative complications between the two groups.Complication rate in group A was 7,1% and in group B was 57%. The difference was statistically significant (p ⫽ 0,01). Mortality was 7,1% in group B. Conclusion: Perioperative enteral immunonutrition seems to lead to fewer surgical complications in patients undergoing major head and neck surgery irrespective their nutritional status, therefore wider use of perioperative enteral immunonutrition should be considered. Significance: This is the first study looking at the use of perioperative enteral immunonutrition in patients undergoing major head and neck surgery with considerable impact on the final outcome.
Research Forum—Tuesday P101