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.
| Question | Level | N(%) |
| Surgeon Type | Plastic Surgeon | 112 (13.0) |
| Oral Surgeon | 752 (87.0) | |
| Clinical Setting | University | 63 (7.7) |
| Private Practice Solo | 345 (2.2) | |
| Group Practice | 324 (39.6) | |
| Private Practice and University | 86 (10.5) | |
| Change in Surgeries in the Past 5 Years | Increased | 60 (7.5) |
| Decreased | 565 (70.5) | |
| Stayed the Same | 176 (22.0) | |
| Problems with Insurance a Cause Fee-for-Service | No | 129 (22.8) |
| Yes | 436 (77.2) | |
| Currently Use/Will Continue to Use | 429 (60.6) | |
| Currently Use/Plan to Stop | 62 (8.8) | |
| Do Not Use/Plan to Start | 35 (4.9) | |
| Do Not Use/Do Not Plan to Start | 182 (25.7) | |
| Use Fee-for-Service Now | Do Not Use | 217 (30.6) |
| Currently Use | 491 (69.4) | |
| Plan to Use Fee-for-Service in the Future | Do Not Plan to Use in the Future | 244 (34.5) |
| Plan to Use in the Future | 464 (65.5) | |
| Amount of Necessary Insurance Increase for Expansion | 25% | 4 (1.0) |
| 50% | 59 (14.8) | |
| 75% | 60 (15.1) | |
| 100% | 121 (30.4) | |
| 200% | 154 (38.7) |