June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Federal Payments to Ophthalmologists: Analysis of Charges and Collections from the Center for Medicare and Medicaid Services 2012-2014
Author Affiliations & Notes
  • Ashvini Reddy
    Ophthalmology, Wilmer Eye Institute, Johns Hopkins, Baltimore, Maryland, United States
  • Gregory Bounds
    School of Public Health, University of Texas, Houston, Texas, United States
  • Sophie J Bakri
    Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
  • Jennifer E Thorne
    Ophthalmology, Wilmer Eye Institute, Johns Hopkins, Baltimore, Maryland, United States
  • Michael X Repka
    Ophthalmology, Wilmer Eye Institute, Johns Hopkins, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Ashvini Reddy, None; Gregory Bounds, None; Sophie Bakri, None; Jennifer Thorne, None; Michael Repka, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5072. doi:
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      Ashvini Reddy, Gregory Bounds, Sophie J Bakri, Jennifer E Thorne, Michael X Repka; Federal Payments to Ophthalmologists: Analysis of Charges and Collections from the Center for Medicare and Medicaid Services 2012-2014. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5072.

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

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Abstract

Purpose : To analyze charges and collections from Center for Medicare and Medicaid Services (CMS) to better understand the relationship between physician productivity and codes corresponding to physician-administered drug charges on federal reimbursement. Release of federal data and analysis of Healthcare Common Procedure Coding System (HCPCS) codes offers the opportunity to better understand (1) the value of services provided by ophthalmologists, (2) the complexity of billing in specialty practices, and (3) the impact of physician-administered drugs on federal collections.

Methods : Retrospective review of the CMS database for payments to ophthalmologists from 2012 - 2014.Total payments to and number of charges by individual ophthalmologists were calculated and separately analyzed by place of service. Mean values were compared using a single T-test and medians were compared by a single Wilcoxon rank-sum test. Primary outcome measures were mean and median CMS payments to ophthalmologists in non-facility and facility based settings. Secondary outcome measures were types of charges most commonly submitted and the number and value of physician-administered drug charges.

Results : From 2012 to 2014, ophthalmologists collected $23,089,609,388 from CMS, and $6,873,331,235 in collections (29.8%) was reimbursement for physician-administered drugs. The drug codes associated with the greatest payments from CMS during this time period were ranibizumab (J2778, $2,579,495,535), aflibercept (J0178 / Q2046, $3,774,217,816), and bevacizumab (J9035 / J3590, $245,016,047). The states with the highest percentage of physician-administered drug charges were Iowa (51.2%), Nebraska (47.7%), and North Dakota (44.6%). The states with the lowest percentage of physician-administered drug charges were Wyoming (6.8%), Vermont (9.5%), and South Carolina (9.8%).

Conclusions : J and Q codes for physician-administered drugs accounted for 29.8% in payments to ophthalmologists from 2012 - 2014. Collections from drug charges vary greatly by state. The choice of costly medications for individual patients has macroeconomic consequences at the national level but is not as great a source of physician profit as the raw data suggests.

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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