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A Revised Estimate of Costs Associated With Routine Preoperative Testing in Medicare Cataract Patients With a
Catherine L Chen1,2,3, Theodore H Clay4, Stephen McLeod5
1Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco.
JAMA Ophthalmology
|January 19, 2018
Summary
Routine preoperative medical testing for cataract surgery is common and costly, even outside the standard 30-day window. Avoiding unnecessary tests between ocular biometry and surgery can reduce Medicare costs.
Area of Science:
- Ophthalmology
- Health Economics
- Health Services Research
Background:
- Routine preoperative medical testing is generally not recommended for low-risk surgeries, yet it is frequently performed.
- The extent of testing outside the conventional 30-day preoperative window is not well understood.
Purpose of the Study:
- To identify and quantify routine preoperative testing performed after the decision for cataract surgery.
- To improve cost estimates for preoperative testing in cataract surgery patients.
Main Methods:
- A cross-sectional study analyzed Medicare beneficiaries over 66 undergoing ambulatory cataract surgery in 2011.
- Ocular biometry was used as a marker for the start of the routine preoperative testing window.
- Testing rates and costs were compared between the period before biometry and the interval between biometry and surgery.
Main Results:
- Over 440,000 patients were included; 96.1% had ocular biometry.
- Testing rates increased from 1.1 tests/patient/month pre-biometry to 1.7 tests/patient/month post-biometry.
- Routine preoperative testing cost Medicare an estimated $45.4 million annually, with significant costs incurred outside the 30-day window.
Conclusions:
- Routine preoperative medical testing for cataract surgery is more frequent and expensive than previously reported.
- Costs are driven by testing conducted prior to the 30-day preoperative window.
- Eliminating routine testing between ocular biometry and cataract surgery could be a significant cost-saving measure.
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