Abstract
Purpose :
To characterize trends in service volume and inflation-adjusted Medicare reimbursement rates of vitreoretinal procedures over the last two decades.
Methods :
Medicare Part B National Summary Data Files were accessed to identify the number of allowed services for vitreoretinal procedures. The Medicare Physician Fee Schedule (PFS) was accessed to identify average national reimbursement rates for each calendar year. Spearman correlation coefficient was used to evaluate time trends for each procedure for both reimbursement and service volume. All analyses were conducted using Prism 9.5.1 with 2-sided significance testing with α = 0.05.
Results :
From 2000 to 2021, two-tailed Spearman correlation between time and service volume showed 20 of 38 analyzed procedures to have statistically significant decreases in service volume. Of note, intravitreal injections increased from 2922 injections in 2000 to 3,444,500 injections in 2021 (rho = 0.997, p < 0.001). Panretinal photocoagulation treatments declined from 104,865 to 48,533 procedures (rho = -0.966, p = 0.003). Scleral buckling declined from 6,502 to 587 procedures (rho = - 0.999, p < 0.001). Pars plana vitrectomy-associated procedures increased from 71,039 to 95,429 (rho = 0.691, p < 0.001). Photodynamic therapy decreased from 126,870 procedures in 2004 to 1,594 procedures in 2021 (rho = 0.803, p < 0.001).
The annual inflation-adjusted expenditure of all vitreoretinal procedures increased from $535 million in 2000 to a peak of $742 million in 2010 and has since decreased to $514 million in 2021. The mean inflation-adjusted reimbursement percentage change for all vitreoretinal procedures was -32% from 2000-2021. Two-tailed Spearman correlation between time and inflation-adjusted reimbursements showed 29 of 38 procedures to have statistically significant decreases over time. Intravitreal injections had a strong negative correlation (rho = 0.974, p < 0.001) with a total payment decrease of 66%. The largest payment decrease was panretinal photocoagulation with a 73% reimbursement cut over the last two decades.
Conclusions :
Vitreoretinal practice patterns have changed dramatically over the past two decades with significant declines in Medicare reimbursement for most procedures. Awareness of service volume and reimbursement trends is vital to assessing both economic viability and patient coverage under the current Medicare payment policies.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.