Abstract
Purpose :
To investigate utilization and payment of Laser Trabeculoplasty (LTP) performed by ophthalmologists and optometrists in three key US states based on CMS Public Use File.
Methods :
We analyzed the Medicare Provider Utilization and Payment Data furnished by the CMS to identify LTP (CPT code 65855) claims in three key US states with optometric-expanded surgical authority in 2015 and 2018. We utilized regression, chi-square, and two-way t-tests to compare PUF metrics.
Results :
The total sum of Medicare allowed payments to ophthalmologists and optometrists performing LTP amongst Fee-for-Service (FFS) Medicare beneficiaries in the US in 2018 was about 33% lower compared to 2015 while the total sum of Medicare Allowed payments in Kentucky (KY), Louisiana (LA), and Oklahoma (OK) in 2018 was about 26% lower compared to 2015. However, the optometric proportion of total Medicare allowed payments furnished by optometrists in three states increased from 11.3% to 17.9% between 2015 and 2018 (Fig. 1). Additionally, we observed significant increases in optometric-to-ophthalmologic average Medicare allowed payments between 2015 and 2018 in KY, LA, OK, and the tri-state cohort (all p<0.001) (Table 1). Significant optometric-to-ophthalmologic ratio increases in summed provider counts (p=0.007), summed unique Medicare beneficiary counts (p<0.001), and ultimately, summed service counts (p<0.001) were observed. Uniquely, we noticed that only one state amongst our tri-state cohort, LA, displayed non-significant differences in all three categories (p=0.91, p=0.35, p=0.29, respectively), despite significantly disproportionate changes in summed Medicare allowed LTP payments (p<0.001). Within the ophthalmologic cohort, female-to-male provider ratio significantly increased (p=0.008); however, the optometric cohort demonstrated no significant increases (p=0.99).
Conclusions :
Optometric surgical authority is a continually expanding landscape throughout the United States. We investigated the latest edition of the CMS Medicare database to characterize LTP-associated metrics between ophthalmologists and optometrists in KY, LA, and OK states. Between 2015 and 2018, optometrists significantly increased their share of LTP-associated Medicare-allowed payments, unique beneficiary counts, service provider counts, and provider service counts.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.