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Dan Gong, Jessica Maslin, Ji Liu, James C Tsai, Christopher Teng; A Quantitative Analysis of Medicare Payment and Retina Procedural and Surgical Volume from 2005 to 2009. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5074.
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© ARVO (1962-2015); The Authors (2016-present)
Previous research has shown that there is no significant association between Medicare payment and procedural volume for intravitreal injection and retinal laser procedures. However, this relationship has not been studied for other retina procedures and surgeries. In a retrospective, longitudinal database study, we analyzed this payment-volume relationship for four commonly performed retina procedures and surgeries: mechanical vitrectomy with pars plana approach (CPT 67036), vitrectomy with endolaser panretinal photocoagulation (CPT 67040), retinal detachment prophylaxis with photocoagulation (CPT 67145), and photodynamic therapy (CPT 67221).
Payment data was collected from the Medicare Physician Fee Schedule from 2005 to 2009, and volume data was collected from the Medicare Part B Carrier Summary Data Files. Using a fixed effects regression model with Medicare Part B carrier and years as the unit of analysis, we calculated the Medicare payment-service volume elasticity, defined as the percent change in Medicare service volume per 1% change in Medicare payment, for the four retina procedures and surgeries by controlling for stable carrier-specific characteristics and national trends in procedural and surgical volume. All analyses also adjusted for inflation and controlled for Medicare beneficiary population, the number of ophthalmologist per region, and income per capita.
No significant associations were found between Medicare payment and service volume for any of the four retina procedures and surgeries. For CPT 67036, elasticity = -1.99 (95% CI [-5.16, 1.17], p = 0.21). For CPT 67040, elasticity = -0.15 (95% CI [-0.54, 0.25], p = 0.46). For CPT 67145, elasticity = 0.18 (95% CI [-0.47, 0.83], p = 0.58). For CPT 67221, elasticity = 0.30 (95% CI [-1.52, 2.12], p = 0.74).
Our study supports previous research finding that there exists no association between Medicare payment and retina service volume. These findings can help guide future projections in Medicare spending for retina procedures and surgeries.
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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