You can make more money doing H&N compared to general ENT.
It is possible, but as I've posted on another thread, there's math to show that that's not necessarily the rule. (This math is a couple years old, but I'm too tired to see what the new allowable is).
Let's say I do a 41155 (Glossectomy; composite procedure with resection floor of mouth, mandibular resection, and radical neck dissection), but not the free flap--I'll leave that for the plastics guy. Let's say the patient already got trached for the sake of argument.
The RVU for that procedure is 73.52 and the medicare allowable is $2600.20 (nice of them to tack on the 20 cents)
Now let's look at 69346 (bilateral tubes). The RVU is 4.27, the medicare allowable is $153.49.
So for the math, let's say the H&N case takes me 6 hours. How many tubes can I get done in 6 hours? Well, I can do 4 an hour fairly easily if I'm running two rooms. So I can theoretically get 24 done. That's a bit of overkill. But for the sake of argument let's look at the numbers--that's $3683.76. Ok, so if we use a more realistic number and say I get 18 cases in that timeframe--that's assuming 3/hr probably fairly low estimate, I still make $2762.82.
Now, some people would say why the heck would I want to do 18 tubes instead of a cool case like the composite resection. Good question. Many wouldn't. I know I have no interest in doing 18 tubes in a day. But let's say I do 4 sets of tubes, 2 tonsils on kids under 12, and a medium level 4 sinus FESS. That would add up as follows 4x153.49 + 2x268.51 + 1245.43 = $2396.41.
Well, I'm down $300, but I'm out by noon instead of 3 or 4PM so I have a lucrative afternoon clinic I can still do and make that up and more by 3 or 4PM. I won't have to round on the H&N patient for $0 for the next 7-10 days. I won't have as significant a risk of multiple complications. I won't need to see that patient every month for the next year. And keep in mind that every visit in the first 90 days is free. Well, free isn't a big deal you say because I got a lot for the surgery.
Then think about this. Every minute you spend seeing that patient without making money, you're losing money. Your staff still makes a salary, you still have rent or a mortgage, you have equipment costs, EMR costs, taxes, insurance, IT costs, etc. In addition, every minute you see that guy, you're not seeing someone who will make money. So it's not a net zero for that 15 mins checking up on him at his 1 month appt. It's zero, minus your overhead, minus the money you would have made seeing someone who would have paid.
I guarantee I make more money in a non H&N practice in my neighborhood than my good H&N colleagues who do. When we've compared notes, it works out to be about 10% more for those who do over 50% H&N. That's not much overall, but on average they work about 10-15% more hours than I do. Nevertheless, they have far more interesting cases. Although, the occasional crazy FESS is still way better than a H&N case in my opinion.