Longitudinal evidence on punctal plug use in an elderly population.

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.