Trends in Medicare Reimbursement for Common Vitreoretinal Procedures: 2011 to 2020

Deruyter, Nicolaas P.; Patel, Shriji; Chen, Qingxia; Leder, Henry A.; Leung, Ella H.; Reddy, Rahul; Blim, Jill; Awh, Carl C.; Hahn, Paul

doi:10.1016/j.ophtha.2022.01.019

Cited by 7 publications

(6 citation statements)

References 5 publications

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“…Asahi et al20 found that vitreoretinal procedures faced a 25% decline over the years 2000 to 2020. Other studies have shown similar decreasing Medicare reimbursement rates for various commonly performed ophthalmic and oculoplastic procedures 20–23. A study by Gong et al (2017) evaluated the effect of the Medicare PFS on service volume for cataract surgery and found a statistically significant increase in the number of complex cataract surgeries performed between 2005 and 2009, which was also a time when Medicare payments were reduced 24…”

Section: Discussionmentioning

confidence: 97%

United States Medicare Reimbursement Trends for Glaucoma Procedures: 2000–2020

Francone

Pham

Asahi

et al. 2022

Journal of Glaucoma

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Purpose: The purpose of this study is to investigate US Medicare reimbursement trends for common glaucoma procedures from 2000 to 2020. Materials and Methods: Current Procedural Terminology codes for Glaucoma procedures in the US centers for Medicare and Medicaid Services database were used to conduct this economic analysis. Reimbursement data from the Physician Fee Schedule look-up tool from the Centers for Medicare and Medicaid Services were compiled for the selected procedures and compensation trends were investigated after adjusting for inflation in 2020 US dollars from the unadjusted data between 2000 and 2020. Results: The average adjusted reimbursement for the analyzed procedures decreased by 20.5% [95% confidence interval (CI), −15.4% to −25.6%] over the 20-year period. On average, there was a 1.03% decrease in reimbursement rates per year (95% CI, −0.74% to −1.33%), with an adjusted compound annual growth rate of −1.35% (95% CI, −1.07% to −1.64%). The results show an overall declining rate in reimbursement for the glaucoma procedures analyzed in this study. Conclusions: The US Medicare reimbursement for glaucoma procedures in the United States showed a significant decline between 2000 and 2020. These findings may be relevant to understanding changing practice patterns for glaucoma care.

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Section: Discussionmentioning

confidence: 97%

United States Medicare Reimbursement Trends for Glaucoma Procedures: 2000–2020

Francone

Pham

Asahi

et al. 2022

Journal of Glaucoma

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“…18 When surgical reimbursements were adjusted for inflation, the overall decline was even greater. 19…”

Section: Discussionmentioning

confidence: 99%

Opportunity Cost of Retinal Detachment Surgery vs Office-Based Patient Care

Leung¹,

Leder²,

Patel

et al. 2022

Journal of VitreoRetinal Diseases

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Purpose: This work compares physician reimbursements for retinal detachment (RD) surgery with office-based patient care. Methods: A theoretical model was constructed from the physician’s perspective for performing a 90-minute uncomplicated RD surgery with its associated perioperative work in the global period (Current Procedural Terminology code 67108) compared with managing 40 patients per 8-hour clinic day in the equivalent time period. The reimbursement rates were based on the 2019 values set by the US Centers for Medicare and Medicaid Services (CMS). Sensitivity analyses were performed varying the perioperative times, clinical productivity, and postoperative visits. Results: The CMS physician reimbursement rate for 67108 surgery was 17.13 work relative value units (wRVUs); meanwhile, the physician in the reference case could have generated 40.89 wRVUs in the office. CMS reimbursement therefore represented a 58% opportunity cost relative to lost office productivity for the physician. A significant disparity was still present even when modeling 30 patients per day. In sensitivity analyses, clinical productivity exceeded surgical compensation in 99% of modeled scenarios. In threshold analyses, the surgeon in the reference case would have to complete the surgery and all immediate perioperative care within 18 minutes to equal the total CMS valuation. Conclusions: CMS reimbursement for RD surgery resulted in a significant opportunity cost for the physician relative to office-based patient care, which was more pronounced for more efficient clinicians in the office. The sensitivity analyses supported the robustness of the model. Reductions in surgery reimbursements relative to office-based patient care might disincentivize busy clinicians.

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Section: Introductionmentioning

confidence: 99%

“…4 Likewise, Medicare reimbursements for common vitreoretinal procedures have been declining over the years. 5 Performing retinal detachment repair has been shown to be associated with a significant opportunity cost for the vitreoretinal surgeon. 6 The purpose of the current analysis was to compare Medicare physician reimbursements for the most common vitreoretinal surgeries against the potential reimbursements the physician could have generated by managing patients in the office during the equivalent time within the 90-day global period.…”

Section: Introductionmentioning

confidence: 99%

Opportunity Cost of Vitreoretinal Surgeries

Leung¹,

Patel

Reddy

et al. 2023

Journal of VitreoRetinal Diseases

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Purpose: To compare physician reimbursements for vitreoretinal surgeries with office-based patient care. Methods: A theoretical model was performed comparing physician work reimbursements for the 10 most common vitreoretinal surgeries with office-based work relative value units (wRVUs) that could have been generated during the same global time period. The reference physician was modeled at 40 patients per 8-hour workday. A lower volume physician and higher volume physician were modeled at 30 patients/day and 50 patients/day, respectively. The reimbursement rates and allocated times for surgery were based on the 2021 values set by Medicare, and the average wRVU per office visit was based on 2021 real-world data from the Vestrum Retinal Healthcare Database. Results: In the reference case, performing any of the 10 most common vitreoretinal surgeries was associated with an opportunity cost with a weighted mean of 49% (range, 40%-68%) relative to lost office productivity. The Centers for Medicare & Medicaid Services (CMS) allocated a weighted mean intraservice time of 73 minutes; however, the reference physician would have to complete the surgery with a weighted average of 5 minutes (range, −31-12 minutes) for surgical wRVUs to equal office-based reimbursements. Performing these 10 surgeries was associated with a 25% opportunity cost even for the lower volume physician and 61% for the higher volume physician. Probability sensitivity analysis with a range of conditions identified opportunity costs from surgery in over 99% of simulated scenarios. Conclusions: Medicare reimbursements for the physician work component of vitreoretinal surgeries represented a significant opportunity cost for the physician relative to office-based patient care of equivalent time, especially for busier physicians. The model did not explore practice overhead and professional liability insurance, which are factored separately by CMS and may influence the opportunity cost depending on utilization. The average threshold surgery times for surgical reimbursements to equal office-based reimbursements may be difficult to achieve.

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Trends in Medicare Reimbursement for Common Vitreoretinal Procedures: 2011 to 2020

Cited by 7 publications

References 5 publications

United States Medicare Reimbursement Trends for Glaucoma Procedures: 2000–2020

United States Medicare Reimbursement Trends for Glaucoma Procedures: 2000–2020

Opportunity Cost of Retinal Detachment Surgery vs Office-Based Patient Care

Opportunity Cost of Vitreoretinal Surgeries

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