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Comparison of Incremental Costs and Medicare Reimbursement for Simple vs Complex Cataract Surgery Using Time-Driven
David S Portney1, Sean T Berkowitz2, Desmond C Garner2
1Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
JAMA Ophthalmology
|March 9, 2023
Summary
Complex cataract surgery costs more than reimbursement, leading to a net loss for providers. This economic disparity may impact ophthalmologist practice patterns and patient access to care.
Area of Science:
- Ophthalmology
- Health Economics
- Surgical Outcomes
Background:
- Cataract surgery is a common ophthalmologic procedure.
- Complex cataract surgery demands more resources than simple cases.
- Current reimbursement for complex cases may not cover increased costs.
Purpose of the Study:
- To compare day-of-surgery costs and net earnings for simple versus complex cataract surgery.
- To evaluate the economic impact of reimbursement rates for complex cataract procedures.
Main Methods:
- Economic analysis using time-driven activity-based costing.
- Inclusion of 16,092 simple and complex cataract surgeries (2017-2021).
- Process flow mapping and analysis of operative-day costs, including supplies and time.
Main Results:
- Complex cataract surgery incurred $877.85 more in day-of-surgery costs than simple cases.
- Incremental reimbursement for complex surgery was $231.01.
- Complex cataract surgery resulted in a net earnings difference of -$646.84 compared to simple surgery.
Conclusions:
- Incremental reimbursement for complex cataract surgery undervalues resource costs.
- The findings suggest a potential negative financial impact on providers.
- Reimbursement adjustments may be necessary to ensure provider viability and patient access to care.
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