A Cost and Policy Analysis Comparing Immediate Sequential Cataract Surgery and Delayed Sequential Cataract Surgery From the Physician Perspective in the United States

Abstract

mprovements in cataract surgery have led to the controversial subject of whether both eyes' cataract surgeries should be performed in the same surgical visit but as separate, independent procedures with one immediately after the other, immediate sequential cataract surgery (ISCS). The current standard of care in the United States is delayed sequential cataract surgery (DSCS), performing each eye's surgery independently with a period of days to months between the 2 eyes' surgeries. There is a scarcity of economic analyses that compare ISCS with DSCS, and the only US-based analysis was a cost-minimization analysis from the payer and patient perspectives, which found that the likely combined Medicare and patient cost reduction would be $783 million with a switch from DSCS to ISCS. 1 Same-surgical setting second-eye cataract surgery reimbursements vary greatly from country to country: ranging from 50% to 85% of the first-eye fee for different Canadian provinces, 50% of the first-eye fee for Medicare, and 80% of the first-eye fee in the United Kingdom. 2 To my knowledge, no studies have evaluated the effect of transitioning from DSCS to ISCS on physician practices. This article will use the same cost-minimization analysis model that was used for the payer and patient perspectives but will try to fill in this gap by performing a US-based analysis from the physician perspective. 1 MethodsStatistical analysis and spreadsheets were analyzed using Microsoft Excel 2007. The single specialty ophthalmology private practice (Eye Clinic) and the ambulatory surgery center (ASC) consented to the use of their data in this analysis. These entities provide care to a mixed small city and rural area in West Tennessee.The ASC's 2011 Medicare Cataract Surgery volume was 1598. The proportion of complex cataract surgery (Current Procedural Terminology code 66982) was 9.3%. A demographic study of surgical patients from the previous model found that 70.9% of patients were having cataract surgery performed on both eyes and 31% of patients were comanaged with optometrists. 1 The number of patients who could undergo ISCS at the 25%, 50%, and 75% eligibility levels was obtained from the payer and patient cost-minimization model. 1 The surgical IMPORTANCE A cost analysis was performed to evaluate the effect on physicians in the United States of a transition from delayed sequential cataract surgery to immediate sequential cataract surgery. Financial and efficiency impacts of this change were evaluated to determine whether efficiency gains could offset potential reduced revenue.OBSERVATIONS A cost analysis using Medicare cataract surgery volume estimates, Medicare 2012 physician cataract surgery reimbursement schedules, and estimates of potential additional office visit revenue comparing immediate sequential cataract surgery with delayed sequential cataract surgery for a single specialty ophthalmology practice in West Tennessee. This model should give an indication of the effect on physicians on a national basis. A single specialty ophthalmology p...

Immediate Sequential vs. Delayed Sequential Bilateral Cataract Surgery

“…Despite the potential economic benefit to payers, patients, and society, 21, 22 the current Medicare reimbursement model is a barrier to widespread adoption of ISBCS surgery in the U.S. 23 due to a reduction in total reimbursement compared to DSBCS. 24 Future research to investigate the impact on the patient’s experience and access to cataract surgery may demonstrate that, combined with high-quality clinical processes, ISBCS surgery is a valuable modality to improving the effectiveness, safety, and experience of care.…”

Benefits and risks of immediately sequential bilateral cataract surgery: a literature review

“…A Western TN patient of Medicare would have saved US$329–US$649 in direct medical and travel costs and lost wages. However, when the same cost variables were applied to estimate what the transition from DSBCS to ISBCS would have cost a cataract surgical clinic in Western TN, physicians bore a net loss of US$19 900–US$91 700, mainly due to discounted Medicare reimbursement rates for ISBCS . The savings from increased efficiency and the additional revenue from having more office visits did not compensate for the rate loss.…”

“…However, when the same cost variables were applied to estimate what the transition from DSBCS to ISBCS would have cost a cataract surgical clinic in Western TN, physicians bore a net loss of US$19 900-US$91 700, mainly due to discounted Medicare reimbursement rates for ISBCS. 17 The savings from increased efficiency and the additional revenue from having more office visits did not compensate for the rate loss. However, this physicians' perspective model does not account for when US ophthalmologists sell specialized, premium intraocular lenses (IOLs) to their patients, which cost nearly twice the Medicare reimbursement rate for a cataract surgery.…”

Bilateral Same-Day Cataract Surgery: An Idea Whose Time Has Come #COVID-19

“…11 Beyond the clinical concerns, the fear of malpractice as an outlier with potential complications remains, as does reimbursement. 12 Both pose significant barriers to adoption, but times are changing. We are unaware of any successful malpractice claim based on the performance of ISBCS.…”