Cataract surgery reimbursement may not be enough for some patients


Complex cataract surgery requires more time and resources than simple cataract surgery, and this study shows that additional reimbursement for complex surgery is insufficient to offset the increased costs. increase.  (Image courtesy of Adobe Stock/Dragon Images)

Complex cataract surgery requires more time and resources than simple cataract surgery, and this study shows that additional reimbursement for complex surgery is insufficient to offset the increased costs. increase. (Image credit: Adobe Stock/Dragon Images)

Researchers argue that Medicare reimbursement for complex surgeries actually covers less than two minutes of operative time, which may justify increased reimbursement for surgery.

Complex cataract surgery requires more time and resources than simple cataract surgery, and this study shows that additional reimbursement for complex surgery is insufficient to offset the increased costs. increase.

“After considering the increased supply and material costs ($158.26), and not considering the additional post-operative visits associated with the complex cataract surgery, the remaining incremental reimbursement is $72.75. University of Michigan Ophthalmology and Vision Science. “Considering the cost per minute of surgery ($43.96/min) for surgeons, anesthesiologists, and operating rooms, the incremental payment compensates for less than two minutes of surgery time, which is much more than the required time difference. It is a very small number.”

According to a University of Michigan news release, the study1 The paper, authored by Shahzad Mian, MD, Interim Chair of Portney and Kellogg, analyzed the differences in day-of-surgery costs and net benefits for simple versus complex cataract surgery. A healthcare provider’s measured cost for complex cataract surgery is significantly higher than for simple cataract surgery, making a difference of $877.85. This difference far exceeds the $231.01 incremental reimbursement provided by Medicare, leading to a net “negative” margin for complex cataract surgery.

“This difference may impact ophthalmologist practice patterns and access to care for patients requiring surgical intervention.These findings suggest that ophthalmologists undertake more complex cases and patients. It suggests that they have lost motivation and are leaving academic and referral centers to cover the costs of surgery.”

Accessibility issues for patients requiring more complex surgeries may also arise.

“The downstream implications of this observation have profound implications for ophthalmologists, healthcare systems, and patients, the most vulnerable, including individuals from racial and ethnic minorities who often undergo complex cataract surgery.” ,” Portney wrote.

This study received no external funding and was conducted as part of a quality assessment initiative at the University of Michigan.

Portney reported as the founder and owner of The Lens Newsletter. This study received no external funding and was conducted as part of a quality assessment initiative at the University of Michigan.

reference
1. David S. Portney, MD; Sean T. Berkowitz, MD, MBA. Desmond C. Garner, BA. and others. Comparison of Incremental Costs and Medicare Reimbursements for Simple Versus Complex Cataract Surgery Using Time-Driven, Activity-Based Costing, This is JAMA ophthalmology. DOI: 10.1001/jamaophthalmol.2023.0091



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