Abstract
Purpose :
Cataract surgery co-management is a controversial practice whereby eye care providers other than the surgeon provide postoperative care. We assessed trends and geographic variation in co-managed cataract surgery among U.S. Medicare enrollees.
Methods :
Using a 20% sample of Medicare enrollees, we identified all patients undergoing ≥1 cataract surgery from 2008-2013. Using the first surgery for each beneficiary, we calculated the number and proportion of surgeries co-managed each year and whether the assisting provider was an optometrist or ophthalmologist. We computed the proportion of co-managed surgeries for all 50 states to determine geographic variation. We also explored whether patients receiving co-managed cataract surgery tended to reside in urban or rural communities and calculated the median travel distance from the patient’s home to the surgeon’s office and to the co-managing provider’s office.
Results :
Co-managed cataract surgeries rose from 47212 of 330870 (14.3%) in 2008 to 57778 of 354365 (16.3%) in 2013. Of patients with co-managed cataract surgery, 76% were co-managed by optometrists. The proportion of cataract surgeries that were co-managed varied considerably from <5% in Vermont and Washington, DC to as high as 45-50% in Wyoming and North Dakota. Midwestern and Mountain region states had the highest proportions of co-managed surgeries (Figure 1). Among 316749 patients with co-managed surgeries, 50% resided in urban areas versus 30% in isolated towns or small rural areas. Among patients co-managed by optometrists (N=240922), median travel distance from the patient’s home to the co-managing optometrist’s office was 8.0 miles, while median travel distance from the patient’s home to the surgeon’s office was 25.7 miles—only 17.7 miles further. For patients not co-managed (N=1726653), median travel distance to the surgeon’s office was 10.0 miles.
Conclusions :
Cataract surgery co-management is slowly increasing over time and there is dramatic geographic variation. While advocates for this practice often argue that co-management spares patients lengthy travel for postoperative care, we found that many patients who are co-managed reside in urban communities and <20 miles from the surgeon’s office. Assuming the actual surgeon is the most qualified person to provide postoperative care, policymakers should re-evaluate whether potential benefits of this practice outweigh risks.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.