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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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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.
[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.
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.
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.
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