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Sulene L. Chi, Kofi Acquah, Michael J. Richard, Frank A. Sloan, Paul P. Lee; Relation between Punctal Plug Usage and Reimbursement amongst Medicare Beneficiaries. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3852.
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To determine whether changes in Medicare reimbursement for punctal plug insertion were associated with a decrease in the incidence of punctal plug insertion and dry eye diagnosis.
Medicare beneficiaries were identified from the Medicare 5% Part-B sample with dry eye diagnoses from 1991 to 2008, as well as those who underwent punctal plug insertion during this time. To ensure that these were incident cases, a 3 year look back period was employed. Dry eye and punctal plug insertion were ascertained from the International Classification of Diseases and Current Procedural Terminology procedure codes. Medicare payment data were obtained from the Centers for Medicare and Medicaid Services from 1994-2008 for punctal plug insertion.
In 2001-2008, inflation-adjusted Medicare reimbursement for punctal plug insertion decreased 55.3% from its maximum in 2001. The Medicare population-adjusted incidence of dry eye diagnosis increased over this time by 28.5%, while first-tine punctal plug insertion rates peaked in the years 2001-2003 and declined by 11.8% from 2001-2008. First-time punctal plug placement in those with a dry eye diagnosis made in the same year peaked in the years 2001-2003 and declined by 23.6% from 2001 to 2008.
Although the frequency of dry eye diagnosis has continued to increase over time, punctal plug insertion has declined in this population coincident with declining Medicare reimbursement for this procedure. This change in practice patterns may be associated with the decrease in Medicare reimbursement, and may also be associated with the introduction in 2003 of RestasisTM, a topical dry eye therapy. Choice of therapies may have cost and humanistic implications.
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