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Vivian S Hawn, Rakin Muhtadi, Pamela Devi Suman, Umar Mian; Expended Effort and Estimated Compensation for Ophthalmological Retinopathy of Prematurity Services at a Single Institution. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2658.
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Retinopathy of prematurity (ROP) is a sight-threatening disease that requires strict, scheduled screening and timely treatment for Type 1 ROP. Examining infants in the neonatal intensive care unit (NICU) confers an added burden for ophthalmologists whose practices are predominantly outpatient. We sought to evaluate the time required to provide ROP services and approximate compensation to better understand incentives for this crucial service.
The ROP coordinator tracked time ophthalmologists spent providing ROP services at two NICUs (2018-2020). Estimated revenue was calculated using appropriate Current Procedural Terminology (CPT) codes for Medicaid reimbursement (2020 Medicare Physician Fee Schedule; Baltimore, MD; CMS.gov). A level 2 inpatient consultation code was used for examinations. Three pediatric ophthalmologists performed screening only (OS), while four retina specialists screened and treated (ST). Total time comprised examination, photography, and administrative duties; travel time at our institution was estimated as 45 minutes. Extrapolation of the time distributions of various ROP services to 100% estimated the physician reimbursement for a hypothetical full-time ROP service.
The ophthalmologists cumulatively spent an average of 108 hours (h.) yearly providing ROP services (8.24% of an annual practice based on a 47-week schedule of 4 days/week, 7 h./day); this increased to 181 h. yearly (13.76% of annual practice) if travel time was included. Estimated annual Medicaid physician reimbursements for OS and ST were $14,655 and $18,182 ($150/h. and $168/h.), respectively; with travel time they decreased to $89/h. and $100/h., respectively. A hypothetical full-time ROP practice would generate annual physician salaries of $196,801 for OS and $220,652 for ST. With travel time, this decreases to $73,655 and $82,631, respectively.
At this institution, performing ROP services requires substantial time, especially if travel among facilities is necessary. This highlights the extensive and costly requirements for the critical task of decreasing ROP blindness. As few ophthalmologists prefer to perform ROP services after training, it is important for hospitals to make this highly litigious field more appealing.
This is a 2021 ARVO Annual Meeting abstract.
Table 1: Average Effort Spent on ROP Services
Table 2: Estimated Average Reimbursement for ROP Services wRVU=work relative value units
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