Insufficient Reimbursements for Cataract Surgery Leave Patients with Financial Burden

A recent study featured in JAMA Ophthalmology reveals that Medicare reimbursements for complex cataract surgery only cover less than two minutes of the operation time. The research suggests that the increase in reimbursements for the procedure may be justified as complex cataract surgery demands more resources and time than simple cataract surgery. The study's findings indicate that the incremental reimbursement for complex cataract surgery is inadequate to counterbalance the higher expenses involved in the process.

"After accounting for the increased supply and material costs ($158.26), the remaining incremental reimbursement is $72.75, even without accounting for the additional postoperative visit associated with complex cataract surgery," Portney wrote. "With the per-minute operative costs of the surgeon, anesthesiologist, and operating room ($43.96/min), the incremental payment compensates for less than 2 minutes of operating time, a number far lower than the required time difference."

Dr. David Portney and Dr. Shahzad Mian from Kellogg conducted the study comparing day-of-surgery costs and net earnings for simple and complex cataract surgery. The findings indicate that the costs for complex cataract surgery are substantially higher than those for simple cataract surgery, with a difference of $877.85. Medicare's incremental reimbursement of $231.01 is not enough to offset these additional costs, resulting in a net negative margin for complex cataract surgery.

"This difference can impact ophthalmologist practice patterns and access to care for patients needing surgical care," said Mian. "These findings suggest ophthalmologists are disincentivized from taking more complex cases and patients, leaving academic and referral centers to cover the cost of the surgeries."

Patients requiring more complex surgery are also likely to experience accessibility issues.

"The downstream effect of this observation has significant implications for ophthalmologists, health care systems, and patients and may particularly affect the most vulnerable patients, including racial and ethnic minority individuals, who more commonly undergo complex cataract surgery," Portney concluded.

Reference

David S. Portney et al, Comparison of Incremental Costs and Medicare Reimbursement for Simple vs Complex Cataract Surgery Using Time-Driven Activity-Based Costing, JAMA Ophthalmology (2023). DOI: 10.1001/jamaophthalmol.2023.0091