Discussion
Ultrasound examination has been likened to the “stethoscope of the
fingers” and carries great value in its immediacy. The ability to clean
it with ease and portabilty allow for ease in use. Point-of-care
ultrasound allows same visit service and management decisions. Its use
has expanded to include ultrasound examination of the thyroid gland,
vocal cord motion, parotid gland, submandibular gland, lymph nodes, head
and neck primary biopsy, arterial evaluation, TEP placement, abscess
drainage, and submucosal cleft evaluation.
Stark differences exist between the subspecialties in terms of billing
procedure. Radiologists (~70%) vastly bill under a
facility while general surgeons (~20%) to a lesser
degree and endocrinologists (~8%) and otolaryngologists
(~5%) much less.
We believe endocrinologists average a higher number of ultrasounds
performed due to spending more time in clinic allowing for point of care
ultrasound. This point is illustrated by the higher number of superusers
within endocrinology (27%). Point of care ultrasound attains a higher
billing rate and reimbursement compared to traditional radiologist
performed ultrasound due to the overwhelming majority of radiology
ultrasonography is performed at a facility. Our study illustrates that,
once adjusting for facility versus non-facility charging, the gap
between the subspecialties lessened. Historically, the non-facility
reimbursement is roughly 3-4 times more –as continued within this
study.
As in other clinical specialties, otolaryngology has been adopting the
concept of point-of-care ultrasound in the new millennium, while
encountering barriers of time, training, confidence, and expense
[5]. There have been concerns that increasing utilization of
clinician performed ultrasound will threaten radiology case volume and
reimbursement [6]. This is the first study that measures relative
utilization between traditional radiology-performed HNUS and that
performed by point-of-care otolaryngologists, general surgeons, and
endocrinologists.