Preoperative consultations for medicare patients undergoing cataract surgery

Area of Science:

• Health Services Research
• Ophthalmology
• Geriatric Medicine

Background:

• Low-risk elective surgeries lack clear guidelines for preoperative consultations.
• Preoperative consultations represent a significant discretionary service in healthcare.

Purpose of the Study:

• To analyze trends, contributing factors, and geographic disparities in preoperative consultations for Medicare beneficiaries undergoing cataract surgery.
• To understand the utilization of preoperative consultations for a common, low-risk elective procedure.

Main Methods:

• A cohort study analyzed a 5% national random sample of Medicare Part B claims from 1995-2006.
• Included 556,637 patients aged 66+ undergoing cataract surgery.
• Examined consultations within 42 days prior to surgery, performed by various practitioners.

Main Results:

• Consultation frequency rose from 11.3% (1998) to 18.4% (2006).
• Factors associated with consultation included older age, urban residence, hospital outpatient facilities, anesthesiologist providers, and geographic region.
• Substantial geographic variation in consultation rates was observed (median 12%, range 0-69%), even after adjustments.

Conclusions:

• Preoperative consultation rates for cataract surgery increased notably between 1995 and 2006.
• Referral patterns suggest influence from nonmedical factors and significant geographic variation.
• Further research is needed to establish evidence-based guidelines for preoperative consultations.