Abstract
Purpose :
Endothelial keratoplasty (EK) is a partial thickness transplant of the posterior cornea, allowing for minimally invasive operations with shorter recovery times and decreased complication rates compared to penetrating keratoplasty. The purpose of this study is to analyze regional and national trends in reimbursement and volume of EK in the Medicare population from 2013-2021.
Methods :
This is a retrospective, observational study utilizing data from Medicare part B National Summary Data Files and Medicare Physician & Other Practitioners by Geography and Service datasets. CPT codes were used to identify volume and reimbursement of keratoplasty types and demographic data was collected from the American Community Survey. Alaska, Wyoming, and Vermont were excluded from analysis due to insufficient data. Trends in volume and reimbursement were analyzed via linear regression and variation via chi-squared GOF. Reimbursement rates were adjusted for inflation to 2021 equivalents.
Results :
The proportion of EK of total keratoplasty spending (r2= 0.977, p<0.0001) has trended upward from 2013-2021. In 2021, there were a total of 21,229 allowed services for EK, accounting for 78.7% of Medicare keratoplasty reimbursement. Upon regional analysis, the South had a volume of 8,421 and accounted for 40.8% of in-facility EK procedures, followed by the Midwest (26.0% 5,366), West (17.5% 3,621), and Northeast (15.3% 3,157). There was significant variation by region when accounting for population. Minnesota, Montana, North Dakota, Ohio, and South Dakota had significant increases in EK volume in the study timeframe, while Georgia, Indiana, Michigan, Missouri, New York, and Virginia had significant decreases. Percent change of average Medicare standardized, inflation-adjusted payment amounts from 2013-2021 ranged from -46.1% to +8.0%.
Conclusions :
Although EK reimbursement (per procedure) increased by 9.5% from 2013 to 2021, inflation-adjusted calculations indicate a 5.6% decline. State-by-state trends in reimbursement varied widely, ranging from marked declines to rises despite inflation. The South and Midwest had a greater than expected volume of procedures, while the Northeast and West had less than expected, likely influenced by regional differences in corneal disease, practice patterns, and resources. Further sub-group analysis of EK is warranted, namely in Descemet Membrane/Stripping EK trends.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.