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Study Identifies a Simple Way to Reduce Health-care Costs in Ear Surgery

MAYWOOD, Ill. - A study led by an Ear, Nose and Throat surgeon at Loyola University Medical Center provides a case study of a simple action that can reduce health-care costs without compromising care.

Matthew Kircher, MD, and colleagues examined one of the costs associated with surgery to remove a type of cyst, called a cholesteatoma, from the middle ear. Otologists routinely send specimens to the pathology lab, but the study found this doesn’t appear to be necessary.

The study found that in 178 cases involving seven otologists, there was virtually perfect agreement between the otologists’ findings and the official diagnoses from the pathology reports. Since the otologists were always right, there appeared to be no need to go through the expense of confirming their findings.

Results are published online ahead of print in the Laryngoscope journal.

The results are similar to other studies that have concluded it’s not always necessary to send tonsillectomy specimens to the pathology lab.

The increased cost of routine cholesteatoma pathologic evaluations should be considered among future health-care cost-containing measures because the clinical utility appears to be low, Kircher and colleagues wrote.

About 18,000 cases of cholesteatoma are treated each year in the United States. Medicare pays $62 for a microscopic evaluation of a specimen, while private insurers can pay much more. Researchers conservatively estimated that not doing these evaluations could save more than $1 million per year.

“Although this number is small when considering the larger context of health-care spending, we believe that this cost analysis represents a simple health-care cost-containment opportunity,” Kircher and colleagues wrote.

A cholesteatoma is a collection of trapped dead cells and other waste material that slough off into a pocket in the middle ear. As the cyst grows, it can break down middle ear bones and other nearby structures, causing hearing loss, dizziness, tinnitus and facial paralysis.

The study was conducted at the Michigan Ear Institute, where Kircher (first author) completed a neurotology fellowship before recently joining Loyola.

Kircher and colleagues reviewed 178 cases and found the “Cohen’s kappa value” between otologists and pathologists was 0.93. A Cohen kappa value measures the agreement between two raters. Statistically, any rating higher than 0.81 is considered a perfect agreement. Researchers said larger studies might help to confirm their findings.

Kircher is an assistant professor in the Department of Otolaryngology at Loyola University Chicago Stritch School of Medicine. His specialties include otology, neurotology and cranial base surgery.

Other authors are Prasad Thottam, DO; Dennis Bojrab, MD; and Seilesh Babu, MD.

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

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