June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Geographic Variation, National Trends, and Characteristics of Patients Receiving Co-Managed Cataract Surgery
Author Affiliations & Notes
  • Nakul Shekhawat
    W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
  • Chris Andrews
    W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
  • Joshua Vrabec
    W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
  • William Richardson
    Georgetown Eye Care, Georgetown, Kentucky, United States
  • Joshua D Stein
    W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, United States
    Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   Nakul Shekhawat, None; Chris Andrews, None; Joshua Vrabec, None; William Richardson, None; Joshua Stein, None
  • Footnotes
    Support  Research to Prevent Blindness, the American Academy of Ophthalmology, WK Kellogg Foundation, National Eye Institute (NEI EY026641)
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5725. doi:
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      Nakul Shekhawat, Chris Andrews, Joshua Vrabec, William Richardson, Joshua D Stein; Geographic Variation, National Trends, and Characteristics of Patients Receiving Co-Managed Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5725.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Cataract surgery co-management is a controversial practice whereby eye care providers other than the surgeon provide postoperative care. We assessed trends and geographic variation in co-managed cataract surgery among U.S. Medicare enrollees.

Methods : Using a 20% sample of Medicare enrollees, we identified all patients undergoing ≥1 cataract surgery from 2008-2013. Using the first surgery for each beneficiary, we calculated the number and proportion of surgeries co-managed each year and whether the assisting provider was an optometrist or ophthalmologist. We computed the proportion of co-managed surgeries for all 50 states to determine geographic variation. We also explored whether patients receiving co-managed cataract surgery tended to reside in urban or rural communities and calculated the median travel distance from the patient’s home to the surgeon’s office and to the co-managing provider’s office.

Results : Co-managed cataract surgeries rose from 47212 of 330870 (14.3%) in 2008 to 57778 of 354365 (16.3%) in 2013. Of patients with co-managed cataract surgery, 76% were co-managed by optometrists. The proportion of cataract surgeries that were co-managed varied considerably from <5% in Vermont and Washington, DC to as high as 45-50% in Wyoming and North Dakota. Midwestern and Mountain region states had the highest proportions of co-managed surgeries (Figure 1). Among 316749 patients with co-managed surgeries, 50% resided in urban areas versus 30% in isolated towns or small rural areas. Among patients co-managed by optometrists (N=240922), median travel distance from the patient’s home to the co-managing optometrist’s office was 8.0 miles, while median travel distance from the patient’s home to the surgeon’s office was 25.7 miles—only 17.7 miles further. For patients not co-managed (N=1726653), median travel distance to the surgeon’s office was 10.0 miles.

Conclusions : Cataract surgery co-management is slowly increasing over time and there is dramatic geographic variation. While advocates for this practice often argue that co-management spares patients lengthy travel for postoperative care, we found that many patients who are co-managed reside in urban communities and <20 miles from the surgeon’s office. Assuming the actual surgeon is the most qualified person to provide postoperative care, policymakers should re-evaluate whether potential benefits of this practice outweigh risks.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

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