April 2014
Volume 55, Issue 13
ARVO Annual Meeting Abstract  |   April 2014
Medicare Payment and Cataract Surgical Volume
Author Affiliations & Notes
  • Dan Gong
    Department of Ophthalmology & Visual Science, Yale School of Medicine, New Haven, CT
  • Jun Lin
    Department of Ophthalmology & Visual Science, Yale School of Medicine, New Haven, CT
  • James C Tsai
    Department of Ophthalmology & Visual Science, Yale School of Medicine, New Haven, CT
  • Footnotes
    Commercial Relationships Dan Gong, None; Jun Lin, None; James Tsai, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 6097. doi:
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      Dan Gong, Jun Lin, James C Tsai; Medicare Payment and Cataract Surgical Volume. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6097.

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

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Purpose: The extent to which Medicare payment impacts cataract surgical volume has not been well quantified. This project studies the Medicare payment-surgical volume elasticity for complex (CPT 66982) and non-complex (CPT 66984) cataract surgeries and determines whether reduced Medicare payment shifts the composition of cataract surgery type from non-complex to complex.

Methods: [i] Payment data (2005-09) from the Medicare Physician Fee Schedule and [ii] surgical volume data from Medicare Part B Carrier Summary Data Files were matched by Medicare Part B carriers. A fixed effects regression model was used to analyze associations between Medicare payment and cataract surgical volume, controlling for [a] stable carrier-specific characteristics causing regional variations in cataract surgical volume, [b] national trends in cataract surgical volume, and [c] national trends in cataract surgery composition including those secondary to increased alpha-blocker use. Shifts between procedures were based on changes in the proportion of total cataract surgeries performed that were complex. All analyses adjusted for Medicare beneficiary population and inflation.

Results: From 2005 to 2009, 658,265 complex cataract surgeries at an average payment of $830.37 (in 2005 $) and 11,593,725 non-complex cataract surgeries at an average payment of $606.70 (in 2005 $) were performed across 55 Medicare carriers. For every 1% decrease in Medicare payment for complex cataract surgery, surgical volume increased by 1.30% (p<0.001). For every 1% decrease in non-complex cataract surgery payment, surgical volume increased by 0.45% (p=0.03). When payment for both procedures decreased by 1%, the proportion of complex cataract surgeries increased by 0.83% (p<0.001). An ophthalmologist performing ten CPT 66982 surgeries at $800 and ninety CPT 66984 surgeries at $600 who experiences a 10% reduction in Medicare payment will recoup more than half (51.6%) of “lost income” from decreased payment by performing more procedures.

Conclusions: Our study demonstrates that reduced Medicare payments are associated with significant increases in cataract surgical volume with greater responses seen for complex cataract surgeries. Moreover, decreased payment leads to a shifting effect from lower-paid non-complex to higher-paid complex procedures. These behavioral offsets are critical for national policymakers to understand when attempting to contain healthcare costs through payment reform.

Keywords: 445 cataract • 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower  

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