Abstract
Purpose :
Pediatric ophthalmologists and adult strabismus surgeons are facing increasing economic pressures, including Medicare reimbursements cuts for strabismus surgery. Recognizing the influences on surgical costs and the duration of surgeries is crucial for clinicians to comprehend and anticipate changing practice trends and healthcare accessibility. The purpose of this analysis is to better understand how multiple factors impact the day-of-surgery costs of strabismus surgery.
Methods :
An economic analysis was carried out using time-driven activity-based costing methodology (TDABC). All strabismus surgeries from 2022 at a single academic center (University of Michigan, Kellogg Eye Center) were included. Cases were assisted by a resident, fellow, or both and were carried out either at an ambulatory surgical center or at a hospital-based outpatient department. Data was obtained using CPT codes 67311-16 via the electronic health record and univariate analysis was conducted to identify the day-of-surgery costs.
Results :
A total of 690 strabismus surgeries were identified from January 1, 2022 to December 31, 2023 across four surgical sites. In pediatric cases (<18 years old), resident-assisted surgeries averaged $880.45 ($595.23-$1165.67, P < 0.01) higher cost and were 9.42 minutes (5.50-13.35 minutes, P < 0.01) longer than fellow-assisted cases. Comparing surgical sites, hospital-based outpatient department cases averaged $1351.62 ($1045.34-$1657.90, P < 0.01) higher cost and were 16.90 minutes (11.32-22.46 minutes, P < 0.01) longer than ambulatory surgical center cases. In adults, reoperations averaged $1271.47 ($939.96-$1602.98, P < 0.01) higher cost and were 23.46 minutes (17.20-29.72 minutes, P < 0.01) longer than primary muscle surgeries.
Conclusions :
Several factors are shown to affect cost and length of strabismus surgery. When compared to reimbursement rates these cost drivers for strabismus surgery can help explain practice patterns, provide opportunity for fair reimbursement advocacy, and increase access to care.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.