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Sunil Srivastava, Pravin Dugel, Kuo Tong, Andrew Layton, Peter Kaiser; A Longitudinal Analysis of 2008-2010 Medicare Claims Data for newly diagnosed macular holes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2836.
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Macular hole typically cause a significant loss of central vision in patients. Pars plana vitrectomy can successfully repair macular hole in most patients. To this point the costs associated with macular hole treatment including vitrectomy surgery and cataract surgery has not been examined. This study evaluates the medicare claims data to identify the cost to Medicare, excluding Part D for newly diagnosed macular hole patients in a two year timeframe
The 2007-2010 US Medicare 5% SAF Carrier (Part B) data was reviewed in order to identify newly diagnosed macular hole patients in 2008 (index year). Patients were included in the study based on age, Medicare enrollment, and index macular hole diagnosis in 2008. Patients who had a claim for macular hole or vitrectomy in 2007 were excluded. Identified claims were then placed into two groups: Group A if a vitrectomy was performed within four quarters of the diagnosis or Group B if a vitrectomy was not performed. All claims for each patient within 24 months following the index diagnosis were screened for ophthalmic indications, surgeries, and medical services based on CPT and E&M codes. Results were analyzed for incidence and costs associated with follow up services following macular hole diagnosis.
A total of 1,897 newly diagnosed macular hole patients were identified. 455 (24%) patients had a vitrectomy within one year (Group A). The average allowed charges for ophthalmic services per patient in Group A over two years was $7,702. The average allowed charges per patient in Group B was $1, 830. Within Group A, 8.8% of cases had combination surgery (vitrectomy and cataract surgery), and 14.5% of cases had at least one additional vitrectomy leading to an additional $4,300 in allowed charges. 50% of Group A patients had cataract surgery compared to 15% in Group B.
Only 24% of newly diagnosed macular hole patients in 2008 had a vitrectomy performed within 1 year. On average, those requiring vitrectomy resulted in a mean $5900 greater cost in claims vs those who did not have vitrectomy. Additional vitrectomy was performed in 15% of macular hole surgery cases resulting in additional $4300 in claims. Cataract surgery was performed more often in those treated with vitrectomy than those who did not have vitrectomy performed
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