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Should Thoracic Surgeons Be Doing EBUS And Other Advanced Bronchoscopic Cases?
*Richard Whyte, Jorind Beqari, Lukas Ritzer, Jennifer Wilson, Sidhu Gangadharan, Adnan Majid, Michael Kent
Beth Israel Deaconess Medical Center, Boston, MA

Background: Bronchoscopic procedures have, historically, been the purview of thoracic surgeons. The development of the field of Interventional Pulmonology (IP) has created a scenario where non-surgeons compete with surgeons for cases done in an operating room. In spite of having a strong theoretical and practical background for doing these cases, relatively few thoracic surgeons have taken up the mantle of this new specialty. We hypothesize that one reason for the relative paucity of surgeons taking up these procedures is because they are perceived as providing less compensation per hour of Operating Room (OR) time; i.e., it is inefficient use of their time. To determine whether such a reimbursement discrepancy exists, we examined actual reimbursement for a variety of thoracic surgical and IP cases.
Methods: Case duration, OR and total patient contact time, billed and actual reimbursements were determined for eight types of thoracic surgical and two types of IP cases in an academic thoracic surgical and IP practice.
Results: Billing and reimbursement data from a total of 464 (366 surgical and 98 IP) cases were reviewed. Thoracic surgical payments per OR hour ranged from $380 to $688 (mean $495). When considering time for post-op management as well, the rates ranged from $270 to $436 (mean $368) (Figure). VATS decortication and open lobectomy had the highest hourly reimbursement rates while mediastinoscopy and laparoscopic hiatal hernia repair were the lowest. For IP cases, the average reimbursement rate was $292 for OR time only—with little difference when accounting for post-procedure care time.
Conclusions: Hourly rates of reimbursement for thoracic surgical procedures were reasonably consistent across procedures and were, on average, 26% greater than IP procedures. Surgeons with busy surgical schedules may be better off encouraging the development of an independent IP practice in their institutions while surgeons with relatively open schedules could capture significant revenue by adopting IP procedures.


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