Abstract
Purpose :
To investigate the relationship between Medicare payment and service volume for 7 high volume retina procedures.
Methods :
This is a retrospective study on a longitudinal dataset including 100% of all retina procedures performed on Medicare Part B beneficiaries within the United States from 2014 through 2019. 7 high volume retina procedures were analyzed, Intravitreal injections (CPT code 67028), Mechanical pars plana vitrectomy (PPV) (CPT 67036), Retinal detachment (RD) repair with vitrectomy (CPT 67108), Complex retinal detachment repair (CPT 67113), Retinal detachment prophylaxis via photocoagulation without drainage (CPT 67145), Destruction of localized lesion of retina via photocoagulation (CPT 67210), Treatment of extensive or progressive retinopathy via photocoagulation (CPT 67228). A fixed-effects regression model was utilized using, Medicare Part B carrier data of the 50 states and District of Columbia. The model accounted for time-invariant carrier-specific characteristics, national trends in service volume, Medicare beneficiary population, number of ophthalmologists, and income per capita. The Medicare payment-service volume elasticity, measures the percent change in service volume per 1% change in Medicare payment.
Results :
For the retina procedures, the regression coefficient representing the Medicare payment-service volume elasticity were nonsignificant for 6 of 7 procedures studied: intravitreal injections, 0.02 (95% CI, -0.40 to 0.44; P = 0.94); Mechanical PPV, -0.40 (95% CI, -1.79 to 0.98; P = 0.57); Complex RD repair, 0.53 (95% CI, -0.84 to 1.91; P = 0.45); RD prophylaxis via photocoagulation without drainage, -0.50 (95% CI, -1.54 to 0.54; P = 0.35); localized retinal lesion destruction via photocoagulation, -0.29 (95% CI, -1.84 to 1.25; P = 0.71); Retinopathy treatment via photocoagulation, 0.37 (95% CI, -0.79 to 1.53; P = 0.53). One procedure had a significant association, for RD repair with vitrectomy by any method, the payment-volume elasticity was 1.43 (95% CI, 0.04 to 2.81; P = 0.04) where for every 1% decrease in payment, service volume increased by 1.43%.
Conclusions :
This study found varying measures of payment-volume elasticities across 7 commonly performed retina procedures suggesting a heterogeneous volume response to changes in Medicare payment for Medicare procedures.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.