Abstract
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