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.