Elsevier

Ophthalmology

Volume 123, Issue 3, March 2016, Pages 505-513
Ophthalmology

Original article
Joint Management of Cataract Surgery by Ophthalmologists and Optometrists

https://doi.org/10.1016/j.ophtha.2015.10.037Get rights and content

Purpose

To estimate the rate and geographic variation of cataract surgery that is managed jointly by ophthalmologists and optometrists in aging Americans.

Design

Database study.

Participants

United States fee-for-service (FFS) Medicare Part B beneficiaries and their providers.

Methods

Medicare Provider Utilization and Payment Data furnished by the Centers for Medicare and Medicaid were used to identify cataract surgery claims among FFS Medicare Part B beneficiaries in all 50 states and the District of Columbia in 2012 and 2013. Payments and joint management rates of cataract surgery by ophthalmologists and optometrists were calculated for each United States state. Geographic variations were evaluated by using the extremal quotient and coefficient of variation (CV).

Main Outcome Measures

Medicare allowed payments for cataract surgery (Current Procedural Terminology codes 66982 and 66984) and number of unique FFS Medicare Part B beneficiaries undergoing cataract surgery.

Results

The overall national rate of joint management of cataract surgery by ophthalmologists and optometrists among FFS Medicare Part B beneficiaries was 10.9% (range by state, 0%–75%) in 2012 and 11.1% (range by state, 0%–63%) in 2013. In 2013, the mean extremal quotient was 67 and the CV was 82.2, demonstrating very high variation in joint management between states. The Medicare allowed payment to optometrists in the joint management of cataract surgery was 2.1% of the total Medicare allowed payments for cataract surgery codes in 2012 and 2013. Twenty percent and 24% of all Medicare-participating optometrists submitted10 or more Medicare claims in the joint management of cataract surgery in 2012 and 2013, respectively.

Conclusions

The overall rate of joint management of cataract surgery by ophthalmologists and optometrists among Medicare beneficiaries was 10.9% in 2012 and 11.1% in 2013. Very high geographic variation was documented, with joint management rates ranging from 0% to 63% across states in 2013.

Section snippets

Data Source

With approval by the Mayo Clinic Institutional Review Board, an observational Medicare database study was conducted. The publicly available Medicare Provider Utilization and Payment Data 2012–2013: Physician and Other Supplier Public Use File (hereafter the Physician and Other Supplier PUF) were obtained from the CMS.11 The CMS created the data set based on information from CMS's National Claims History Standard Analytic Files, which have final-action Medicare Part B FFS claims. These claims

Results

The total Medicare allowed payments to ophthalmologist surgeons and to optometrists involved in the joint management of cataract surgery among FFS Medicare beneficiaries in the 50 United States and District of Columbia were estimated to be $1340789466 in 2012, decreasing 11% to $1188124136 in 2013. By contrast, the number of FFS Medicare beneficiaries having cataract surgery increased 0.8% from 1099142 in 2012 to 1107900 in 2013 (Table 1). Our data do not include the approximately 28% of

Discussion

By using publicly available 2012 and 2013 FFS Medicare databases, our study provides the most recent and most complete descriptive epidemiologic characteristics of the joint management of cataract surgery by ophthalmologists and optometrists among FFS Medicare beneficiaries. There are several noteworthy findings. First, nationwide, approximately 1 in 10 FFS Medicare Part B beneficiaries who underwent cataract surgery in 2012 and 2013 had their postoperative care managed jointly by an

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  • Cited by (7)

    • Billing of cataract surgery as complex versus routine for Medicare beneficiaries

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      The highest rates were in the Southeast and Midwest (regions with lower use of complex cataract surgery codes in our study). However, additional research would be needed to explore the underlying causes for the geographic variation in the use of complex cataract surgery codes that we observed.23 We hypothesize that the patient-level differences we identified for complex cataract coding might have been attributable to underuse of and/or delayed access to appropriate ophthalmic care in these patient populations, leading to more mature cataracts at presentation.

    • Comparing Access to Laser Capsulotomy Performed by Optometrists and Ophthalmologists in Oklahoma by Calculated Driving Distance and Time

      2017, Ophthalmology
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      In 2014, 16 years after receiving laser privileges, Oklahoma optometrists represent 42% of all Oklahoma YAG laser capsulotomy providers who submitted >10 claims to Medicare and performed 33% of all YAG laser capsulotomies. Likewise, approximately 27% of all cataract surgeries performed on Oklahoma Medicare beneficiaries are jointly managed by optometrists and ophthalmologists.18 Our data are unable to differentiate YAG laser providers who participated in joint cataract surgery management from those who did not.

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    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the Mayo Foundation for Medical Education and Research, Rochester, Minnesota; and Research to Prevent Blindness, Inc, New York, New York. The sponsors or funding organizations had no role in the design or conduct of this research.

    Author Contributions:

    Conception and design: Erie, Hodge, Mahr

    Analysis and interpretation: Erie, Hodge, Mahr

    Data collection: Erie, Hodge, Mahr

    Obtained funding: none

    Overall responsibility: Erie, Hodge, Mahr

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