Economic Impact of Facial Plastic and Reconstructive Surgery: The Case Mix Index

Background: The case mix index (CMI) represents the average medicare severity-diagnosis related group relative weight over a period of time. The higher the CMI, the more the hospital gets reimbursed, on average. Little has been published in regards to CMI within Otolaryngology particularly in Facial Plastic and Reconstructive Surgery. Aim: This study was performed to determine the economic impact of Facial Plastic and Reconstructive Surgery has on hospital medicare reimbursements. Methods: In a retrospective review we analyzed the admissions of facial plastic and reconstructive surgeons as well as general otolaryngologists at a tertiary medical center from October 2015 through May 2018. General otolaryngology excluded pediatrics, otology, and admissions under fellows. The admissions analyzed were limited to patients that required observation or intervention from a plastics perspective. Of the FPRS admissions, there were no patients included that were admitted for oncologic resection or surgeries that would have fallen within other specialties of otolaryngology. The case mix index was then calculated for each admission. Results: There were two facial plastic and reconstructive surgeons and thirteen general otolaryngology surgeons who admitted patients from October 2015 through May 2018. A total of 103 admissions were found to have plastics-only observation or intervention. The average CMI for these patients was 2.92. Of the 1,918 general otolaryngology admissions, the average CMI was 2.62. There were 14 FPRS admissions that had a CMI of less than 1.00, and five of those did not have a procedure completed during the admission. Conclusion: At the studied tertiary care center, case mix index values greater than a value of 2.2 indicated that the average medicare reimbursements per admission surpassed the costs of the admission. The result is a profit for the hospital. As demonstrated in our study, FPRS admissions consistently produced a profit for this tertiary medical center. Furthermore, FPRS admissions resulted in a greater average CMI as compared to admissions under general otolaryngologists.