Monday, October 9, 2006 - 8:30 AM

Orthognathic Surgery: Is There a Future?

Andrea Moreira Gonzalez, MD and James E. Zins, MD.

Purpose: Despite significant technical and technological improvement, orthognathic surgeries appeared to decrease in number in U.S. In an attempt to document this decrease and the causative factors, a survey was sent to plastic surgeons (ASMS) and oral surgeons (AAOMS) around the country. Method: Questions addressed whether number of orthognathic surgeries increased, decreased or remained unchanged over five-year period (1999-2003), and why. Changes in reimbursement levels were also evaluated. Wilcoxon Signed Rank test applied for statistical analysis (p<0.05). Results: 3273 surveys were mailed, 885 were returned (response rate=27.6%). The number of surgeries performed from 1999 to 2003 decreased significantly (p<0.001). 77% of responders claimed lack of approval or insurance reimbursement as reasons for the decrease (Table-1). There was a significant decrease in the reimbursement levels for single and double jaw surgery (p<0.001). In 1999, 51.5% of responders received over $2,500 for single jaw. Currently, only 18% received that value. 70% are currently using fee-for-service. At least 100% increase in reimbursement would be necessary for surgeons to expand their practice. Conclusions: We documented a reduction in number of orthognathic procedures performed in U.S. This is a potentially serious issue that may significantly affect the health care standards for patients with dentofacial deformities.

Surgeon TypePlastic Surgeon112 (13.0)
Oral Surgeon752 (87.0)
Clinical SettingUniversity63 (7.7)
Private Practice Solo345 (2.2)
Group Practice324 (39.6)
Private Practice and University86 (10.5)
Change in Surgeries in the Past 5 YearsIncreased60 (7.5)
Decreased565 (70.5)
Stayed the Same176 (22.0)
Problems with Insurance a Cause Fee-for-ServiceNo129 (22.8)
Yes436 (77.2)
Currently Use/Will Continue to Use429 (60.6)
Currently Use/Plan to Stop62 (8.8)
Do Not Use/Plan to Start35 (4.9)
Do Not Use/Do Not Plan to Start182 (25.7)
Use Fee-for-Service NowDo Not Use217 (30.6)
Currently Use491 (69.4)
Plan to Use Fee-for-Service in the FutureDo Not Plan to Use in the Future244 (34.5)
Plan to Use in the Future464 (65.5)
Amount of Necessary Insurance Increase for Expansion25%4 (1.0)
50%59 (14.8)
75%60 (15.1)
100%121 (30.4)
200%154 (38.7)

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