Chulwoo J Kim, Megalan S Tso, David Z Allen, Merry E Sebelik
While otolaryngologists remain the primary providers of DFL and VLS, APP national annual DFL, VLS, and combined DFL and VLS density is rapidly growing. Insignificant changes in otolaryngologist national annual combined DFL and VLS density suggest stable utilization by otolaryngologists despite rapid growth associated with APPs. The significant growth in national annual VLS utilization suggests increasing adoption of VLS. These findings suggest evolving procedure choices and rapid growth for APPs within otolaryngology, prompting further study of procedural training and outcomes across provider types.
OBJECTIVES: This study aims to evaluate national trends and 2023 state-level variation in diagnostic flexible laryngoscopy (DFL) and videolaryngostroboscopy (VLS) utilization by physicians and advanced practice providers (APPs).
METHODS: This is a repeated cross-sectional analysis of Medicare Part B fee-for-service data from 2015 to 2023, collected in the annual Medicare Provider Utilization and Payment Data: Physician and Other Practitioners Public Use Files and the Medicare Monthly Enrollment data published by the Centers for Medicare and Medicaid Services. Compound annual growth rates (CAGR) and linear and log-linear regression models were calculated to assess trends in APP and otolaryngologist annual DFL, VLS, and combined DFL and VLS volume per 10,000 beneficiaries.
RESULTS: Log-linear analysis indicated no significant change in national annual combined DFL and VLS density (P = 0.786). Conversely, log-linear analysis indicated significant increases in national annual VLS density (P < 0.001) with an increase from 19.7 per 10,000 beneficiaries in 2015 to 29.6 in 2023 (CAGR +5.2%). From 2015 to 2023, APP annual combined DFL and VLS density increased (CAGR +17.2%), while the log-linear model estimates approximately 16.0% growth per year (P < 0.001). Meanwhile, otolaryngologist combined DFL and VLS density did not significantly change (P = 0.085). By 2023, APPs contributed over 20% of the annual combined DFL and VLS density in seven states.
CONCLUSIONS: While otolaryngologists remain the primary providers of DFL and VLS, APP national annual DFL, VLS, and combined DFL and VLS density is rapidly growing. Insignificant changes in otolaryngologist national annual combined DFL and VLS density suggest stable utilization by otolaryngologists despite rapid growth associated with APPs. The significant growth in national annual VLS utilization suggests increasing adoption of VLS. These findings suggest evolving procedure choices and rapid growth for APPs within otolaryngology, prompting further study of procedural training and outcomes across provider types.