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J. R. Valentine, R. Ayyala, MD, FRCS, FRCOphth; A Multicenter Cost Comparison of Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):513.
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To present the cost of cataract surgery in different settings (ambulatory surgical center [ASC], Veterans Hospital [VA] facilities, a state hospital and a university hospital)
A list of fourteen standard surgical items for cataract surgery were submitted to a privately owned university hospital, a state run hospital catering to mostly uninsured patients, two VA Medical Centers and a private ambulatory surgical center. Four of the facilities are located in the state of Louisiana and one in the state of Mississippi. The price sheet included phenylephrine topical eye drops, tropicamide topical eye drops, preservative free lidocaine 1%, decadron injectable, gentamicin, Ringer's solution (IV), Intraocular lens (nonmultifocal), surgical drape, basic salt solution, viscoelastic, surgical gowns, phacoemulsification tubing pack, keratome, and 10-0 nylon suture. The surgeon's fee and anesthesia fees were specifically ignored. The facility’s product cost was compared to the Medicare rate from the Center of Medicare and Medicaid Services for May of 2008.
The total average cost was $502. The intraocular lens cost is similar ($150) between the institutions. Of the 14 items, the university hospital paid more for five items (phenylephrine, lidocaine, decadron, gentamicin, viscoelastic) and tied in one other cost (Ringer's solution). The state run hospital had the highest overall cost of disposable items (1.67 times more than the lowest--$648 verses $387). One of the VA locations had the lowest product costs followed by the ASC ($441), the other VA ($497), the Private hospital ($538), and the state run hospital in increasing order. The ASC medicare reimbursement rate was $976.76 and the hospital medicare reimbursement was $1520.05 for this time period.
There are varying product costs at different facilities. The cost of disposable items used for cataract surgery was generally lower in the VA hospital systems because of strong cost control measures built into oversite practices. When comparing other institutions, an ASC has a higher volume of specific procedures and thus has a higher purchasing power even though hospitals perform a higher total number of cases. In the current public policy movement to cut healthcare expeditures, product costs directly relate to facility costs and these fees are passed on to patients.
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