Related Experiment Video
Updated: Jun 27, 2025
05:58
Retinal Detachment Model in Rodents by Subretinal Injection of Sodium Hyaluronate
Published on: September 11, 2013
20.9K
Academic versus Community Retinal Surgery for Primary Retinal Detachment: Characteristics, Duration, and Value
Ryan S Meshkin1, Jonah Blumenthal2, Sandra Hoyek1
1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Ophthalmology. Retina
|May 2, 2024
Summary
Academic surgeons performing rhegmatogenous retinal detachment (RRD) repairs take longer, especially when fellows are involved. Current Medicare reimbursement for teaching cases significantly underpays for the extra time trainees add.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Health Economics
Background:
- Academic surgeons face longer operative times for primary rhegmatogenous retinal detachment (RRD) repairs compared to community surgeons.
- Fellow involvement in RRD repair significantly increases operative duration in both academic and community settings.
Purpose of the Study:
- To compare operative time and case characteristics of primary RRD repairs between academic and community vitreoretinal surgeons.
- To analyze the cost-effectiveness of Medicare reimbursement for teaching cases in vitreoretinal surgery.
Main Methods:
- Retrospective, observational study of 300 primary RRD repairs from 20 academic and community vitreoretinal surgeons.
- Analysis of operative length, case complexity (macula-off RRDs, combined scleral buckle/pars plana vitrectomy), and presence of fellows.
- Cost analysis of Medicare reimbursement for the teaching modifier versus actual hospital and physician time costs.
Main Results:
- Cases with fellows present were longer (75.7 minutes) than those without (55.0 minutes).
- Academic surgeon cases had more macula-off RRDs (52.7%) and combined scleral buckle/pars plana vitrectomy (14%) versus community surgeons (38.0% and 3%).
- Medicare reimbursement for the teaching modifier covers only 50.9% of the increased physician time cost and 18% of the increased hospital costs.
Conclusions:
- More complex cases (macula-off, scleral buckle) in academic settings contribute to longer operative times.
- Current Medicare reimbursement significantly undercompensates for the additional time and resources required for trainee participation in RRD repair.
