June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Utilization and insurance payments for tele-ophthalmology in the United States over 10 years
Author Affiliations & Notes
  • Sophie Camille Lee
    Ophthalmology, University of California Davis, Sacramento, California, United States
  • Susan Alber
    Ophthalmology, University of California Davis, Sacramento, California, United States
  • Neesurg Mehta
    Ophthalmology, University of California Davis, Sacramento, California, United States
  • Parisa Emami-Naeini
    Ophthalmology, University of California Davis, Sacramento, California, United States
  • Glenn Yiu
    Ophthalmology, University of California Davis, Sacramento, California, United States
    OptumLabs Visiting Fellow, Optum Inc, Eden Prairie, Minnesota, United States
  • Footnotes
    Commercial Relationships   Sophie Lee, None; Susan Alber, None; Neesurg Mehta, None; Parisa Emami-Naeini, None; Glenn Yiu, Allergan (C), Carl Zeiss Meditec (C), Clearside Biomedical (C), Genentech (C), Intergalactic Therapeutics (C), Iridex (C), Regeneron (C), Topcon (C), Verily (C)
  • Footnotes
    Support  OptumLabs Data Warehouse
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2667. doi:
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      Sophie Camille Lee, Susan Alber, Neesurg Mehta, Parisa Emami-Naeini, Glenn Yiu; Utilization and insurance payments for tele-ophthalmology in the United States over 10 years. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2667.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Remote eye screening using tele-ophthalmology has the potential to reduce cost and improve rates of retinopathy screening in patients with diabetes. However, lower insurance reimbursements have limited the financial sustainability of many tele-ophthalmology programs. Here, we performed a retrospective claims-based analysis of tele-ophthalmology utilization and insurance payments using the OptumLabs® Data Warehouse (OLDW) – a comprehensive database of de-identified administrative claims for commercial enrollees in the U.S.

Methods : We analyzed all healthcare claims in OLDW database from 2010-2019 for tele-ophthalmology using Current Procedural Terminology (CPT) codes for tele-ophthalmology 92227 and 92228 for any providers, as well as fundus photography 92250 by non-eyecare providers. We evaluated the number of administrative claims for tele-ophthalmology codes, rates of insurance claim payments or denials, provider specialty and practice setting, as well as age, sex, race/ethnicity, household income, education level, and rural-urban commuting area (RUCA) codes.

Results : Utilization of tele-ophthalmology increased rapidly over the past 10 years, from 51 claims per 100,000 person-years in 2011 when tele-ophthalmology CPT codes were introduced, to 153 claims per 100,000 person-years in 2019. A majority of administrative claims for tele-ophthalmology include at least one diagnostic code for type 1 or 2 diabetes (59%). The rest include a diagnosis of diabetic eye disease (8%) or any eye condition (41%). However, insurance payments for tele-ophthalmology decreased over the 10-year period, from 88% of claims paid in 2011 to 65% in 2019.

Conclusions : Utilization of tele-ophthalmology has increased rapidly over the past 10 years, but insurance payments have declined. Given the potential cost-savings and reduction of in-person eye screening for diabetic patients, insurance providers should be encouraged to improve coverage for tele-retinal services.

This is a 2021 ARVO Annual Meeting abstract.

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