(007) Differential Impact of the COVID-19 Pandemic Across Otolaryngology Subspecialties: A National Medicare Claims Analysis

Introduction: Medicare claim activity in otolaryngology decreased during the COVID-19 pandemic; however, the extent of disruption across subspecialties remains insufficiently characterized. This study investigates the impact of the COVID-19 pandemic on subspecialty-specific Medicare utilization and spending patterns.

Methods: A retrospective study was conducted using Medicare Part B claims data from 2013 to 2023. Representative procedural CPT codes were selected for otolaryngology subspecialties, and changes in annual claim volume and expenditure for these codes were calculated for the pandemic period (2020-2022) relative to 2019. Average volume and spending changes at the CPT level were further examined for each subspecialty using Wilcoxon signed-rank testing with Benjamini-Hochberg false discovery rate correction (q=0.05).

Results: All otolaryngology subspecialties experienced a drop in procedure volume and spending at the onset of the pandemic (2020). Aggregate volume reductions were highest in otology (-36.8%), facial plastics (-30.1%), and rhinology (-28.3%), and lowest in head and neck surgery (-16.5%). Aggregate spending largely followed this same trend. Across CPT codes, on average, volume declines persisted through 2022 for otology, rhinology, and general otolaryngology (Wilcoxon p < 0.01) but recovered for laryngology and facial plastics to pre-pandemic levels (Wilcoxon p > 0.05). Head and neck surgery was the most resilient and did not experience a significant decline in volume or spending across CPT codes during the pandemic (Wilcoxon p > 0.05).

Conclusions: The COVID-19 pandemic had diverging impacts across otolaryngology. Subspecialties with high levels of diagnostic and elective procedures (e.g., facial plastics) saw the largest declines and slowest recovery. Meanwhile, oncologic head and neck care was most preserved, possibly due to prioritization of essential, time-sensitive procedures. These findings highlight subspecialty-specific vulnerabilities to healthcare disruptions and underscore the need for targeted strategies that maintain care access in future emergencies.