Christopher Vanison

Objective: Medicare physician fee schedule (MPFS) reimbursement, historically subjected to complex policy changes, has decreased in numerous surgical specialties after inflation adjustments. Outpatient prospective payment system (OPPS) reimbursement has largely been uninvestigated. This study aims to evaluate monetary trends in Medicare physician and hospital outpatient reimbursement rates for mandibular facial fracture repairs from 2000 to 2024. Methods: The Physician Fee Schedule Tool and Quarterly Addenda Updates provided by the Center for Medicare and Medicaid Services (CMS) were queried for the six most common open mandibular facial fracture procedures. Physician reimbursement rates for facility and non‐facility clinical settings, hospital outpatient reimbursement rates, work relative value units (RVUs), and total billed services pertaining to these six procedures were collected and analyzed. Monetary data was adjusted for inflation to reflect 2024 dollars based on the consumer price index (CPI) released by the US Department of Labor's Bureau of Labor Statistics. Results: Average facility physician reimbursement, after adjusting for inflation, of the six mandibular fracture procedures from 2000 to 2024 decreased by 24.1%. All procedures continuously billed in non‐facility settings exhibited physician reimbursement increases, even after post‐inflation adjustments. Hospital outpatient reimbursement, after adjusting for inflation, from 2004 to 2024 increased by 110.6%. Conclusion: Facility physician reimbursement for mandibular fractures has declined over the past two decades despite increasing hospital compensation and work RVUs. Future reform should incorporate solutions to address declining facility physician compensation in order to mitigate financial strain on providers and barriers to patient access to care.

Radiomic graph analysis of pretreatment CT enables holistic analysis of head and neck squamous cell carcinoma tumors and their surrounding environment, showing good performance in local-regional recurrence and distant metastasis prediction and unique model interpretability.

Objectives Superficial parotidectomy is a common surgery performed by Otolaryngologists. Elderly patients may be undertreated due to perceived complications. Our study aimed to evaluate the differences in early postoperative outcomes in patients over age 75. Methods The National Surgical Quality Improvement (NSQIP) database identified patients undergoing superficial parotidectomy. Cohorts were created for patients younger and older than 75. Bivariate and multivariate analyses compared rates of postoperative complications, reoperation, length of stay and readmission. Subgroup analyses were conducted for benign and malignant disease. Results Our query identified 2472 patients, including 309 elderly and 2163 younger patients. Bivariate analysis showed significantly higher rates of stroke (p = 0.043), readmission (p < 0.001), hospital stay longer than two days (p < 0.001) and need for transfusion (p = 0.026) in elderly patients. On multivariate analsysis, readmission rates (OR: 2.648, 95% CI: 1.035-6.775, p = 0.042) and increased length of stay (OR: 2.405, 95% CI: 1.348-4.298, p = 0.003) were significantly worse in elderly patients. Subgroup analysis showed that elderly patients treated for malignant parotid tumors were more likely to be readmitted (OR: 6.928, 95% CI: 1.293-37.111, p = 0.024). Conclusion Superficial parotidectomy appears to be a safe when performed in elderly patients. Main risks to consider in this population include readmission and increased hospital length of stay. Major postoperative morbidities were not identified on multivariate analysis.