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Longitudinal evidence on punctal plug use in an elderly population
Sulene L Chi1, Kofi F Acquah, Michael J Richard
1Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, USA.
Purpose:
The purpose of this study was to determine whether changes in Medicare reimbursement for punctal plug insertion were associated with a decrease in the incidence of insertion and dry eye diagnosis.
Methods:
Incident cases of dry eye syndrome (DES) diagnoses and punctal plug insertions among Medicare beneficiaries were identified from Medicare 5% Part B from 1994 to 2008, using a 3-year look-back. Dry eye syndrome diagnoses and punctal plug insertion codes were ascertained from the international classification of diseases and current procedural terminology codes. Medicare payment data were obtained from the Centers for Medicare and Medicaid Services from 1994 to 2008 for punctal plug insertion. Rates were calculated for both the incidence of DES and the use of punctal plugs.
Results:
From 2001 to 2008, inflation-adjusted Medicare reimbursement for punctal plug insertion decreased 55.1%, whereas the Medicare population-adjusted incidence of dry eye diagnosis increased 23.3%. Nine percent of individuals diagnosed with DES between 1991 and 2008 underwent punctal plug placement with a mean of 2.0 plugs placed per patient. Total punctal plug placement increased 322.2% between 1994 and 2003, and then reached a plateau. First-time punctal plug insertion rates within 365 days of DES diagnosis increased 111.8% from 1994 to 2002, and then declined 47.0% from 2002 to 2008.
Conclusions:
Although the frequency of DES diagnosis in the Medicare population has increased over time, first-time punctal plug insertion rates, especially within the first year following DES diagnosis, have declined coincidently with the increasing presence of a medical alternative and declining Medicare payment. Choice of therapies may have cost and care implications.
Insights
Medicare reimbursement changes for punctal plugs did not decrease dry eye diagnoses. Instead, dry eye diagnoses increased while punctal plug insertions declined, especially after diagnosis.
Area of Science:
- Ophthalmology
- Health Economics
- Health Services Research
Background:
- Dry eye syndrome (DES) is a common condition affecting many individuals.
- Punctal plugs are a treatment option for DES.
- Medicare reimbursement policies can influence medical procedure utilization.
Purpose of the Study:
- To investigate the association between changes in Medicare reimbursement for punctal plug insertion and the incidence of punctal plug insertion and dry eye diagnosis.
- To analyze trends in DES diagnoses and punctal plug utilization among Medicare beneficiaries.
Main Methods:
- Utilized Medicare 5% Part B data from 1994-2008.
- Identified incident cases of DES diagnoses and punctal plug insertions using ICD and CPT codes.
- Obtained Medicare payment data for punctal plug insertion from CMS.
- Calculated incidence rates for DES and punctal plug usage.
Main Results:
- Inflation-adjusted Medicare reimbursement for punctal plugs decreased by 55.1% from 2001-2008.
- Medicare population-adjusted incidence of DES diagnoses increased by 23.3% during the same period.
- First-time punctal plug insertion rates within 365 days of DES diagnosis declined by 47.0% from 2002-2008 after an initial increase.
Conclusions:
- Despite increasing DES diagnoses in the Medicare population, first-time punctal plug insertion rates have declined.
- This decline coincided with decreasing Medicare payments and the emergence of alternative medical treatments.
- Therapeutic choices have significant cost and care implications for patients and the healthcare system.
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