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Kamyar Vaziri, Andrew Moshfeghi, Tina Hernandez-Boussard, Natalia Fijalkowski, Darius Moshfeghi; Ambulatory Surgery Center (ASC) Utilization by three Ophthalmic Sub-specialists: 1999-2011. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4416.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the utilization of ambulatory surgery centers (ASCs) in Florida for vitreoretinal, cataract, and glaucoma procedures over the years 1999-2008 and to also calculate these trends specifically for the years 2008 to 2011 for glaucoma and cataract surgeries with the purpose of assessing any potential consequences of the new ASC reimbursement system implemented in 2008 by Centers for Medicare & Medicaid Services (CMS) on ASC utilization.
The Healthcare Cost and Utilization Project (HCUP) State Ambulatory Surgery Databases (SASD) for Florida from 1999-2008 were obtained and evaluated. ICD-9 codes for vitreoretinal, Cataract and Glaucoma procedures were queried in this database for each year. For the years 2009-2011, preliminary publicly available data from the same databases (available from: http://www.hcup-us.ahrq.gov/cdstats/cdstats_search.jsp) were used. Joinpoint regression analysis was utilized to assess the trends in ASC utilization by studied sub-specialties by calculating annual percent changes over time.
Over this time period of 1999-2008, average annual percent change (APC) in ambulatory surgery center utilization was +33.6% (95% CI, 4.5% to 70.8%; P = 0.028) for vitreoretinal surgery, +28.6% (95% CI, 1.3% to 63.2%; P= 0.044) for cataract surgery and +35.23% (95% CI, 12.7% to 62.4%; P= 0.0055) for glaucoma surgery. By utilizing the preliminary publicly available data (web address provided above) from the ambulatory surgery center database of Healthcare Cost and Utilization Project (HCUP) for the years of 2009-2011, over the period of 2008-2011, annual percent change in ASC utilization was -14.70% (95% CI, -23.5% to -5.1%; P = 0.0236) for cataract surgery and -20.09% (95% CI, -36.2% to 0.0%; P = 0.050029) for glaucoma surgery. Preliminary public data were not available with regards to vitreoretinal surgery for the years 2009-2011.
There was a significant increase in ASC utilization by vitreoretinal, cataract and glaucoma surgeons in the years 1999-2008, likely due to increased ASC reimbursements and advances in surgical techniques and equipment. However the implementation of the new ASC reimbursement system in 2008, which has led to the widening of the gap between ambulatory surgery center and hospital outpatient department reimbursement rates, appears to have reversed some of these encouraging trends.
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