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Henry D. Jampel, Sandra D. Cassard, David S. Friedman, Harry A. Quigley, Emily W. Gower; Regional Variations In The Rate Of Laser Trabeculoplasty In The Medicare Population. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6349.
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To determine the magnitude of regional variation in the performance of laser trabeculoplasty (LTP).
We studied a 5% random sample of all Medicare beneficiaries aged 65 years or older with continuous Part B (medical insurance) coverage and no enrollment in a health maintenance organization for each year from 2002 to 2008. We counted unique claims with a CPT code of 65855 (LTP) submitted by ophthalmologists, optometrists, ambulatory surgery centers or outpatient hospitals by region for each of seven years. We examined regional variation in rates of LTP in 9 large geographic regions, both by rate per 10,000 beneficiaries and rate per 10,000 diagnosed OAG patients.
The rate of LTP increased from 36/10,000 beneficiaries in 2002 to 58/10,000 in 2005 (61% increase), then remained stable through 2008. Since the rate of diagnosed open angle glaucoma (OAG) differed among the 9 regions studied, we next calculated LTP rates per 10,000 diagnosed OAG patients. The rates by region differed significantly, with some regions recording twice as many as other regions. The rate of laser trabeculoplasty in 2002 ranged from a low of 305/10,000 OAG in the ESC region (AL, KY, MS, TN) to a high of 599/10,000 OAG patients in the ENC (IL, IN, MI, OH, WI) region (96% higher). While rates rose over time in all regions, the increase varied by region. The ESC region showed the greatest increase (2.6 fold, from 305 to 791/10,000 OAG patients); the NE region (CT, MA, ME, NH, RI, VT) the least (16%, from 533 to 616/10,000 OAG patients).
Substantial regional differences in claims for trabeculoplasty raise the possibility that either too many trabeculoplasties are being performed in some regions or not enough are being performed in others. During the 7 years studied, rates significantly increased overall, though the increase was also regionally selective, with doubling in some areas and near stability in others.
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