Time-Driven, Activity-Based Cost Analysis of Secondary Intraocular Lens Implantation

Area of Science:

• Ophthalmology
• Health Economics

Background:

• Secondary intraocular lens (IOL) procedures are often necessary to correct visual deficits after initial cataract surgery.
• These procedures, when combined with pars plana vitrectomy (PPV), represent complex ophthalmic surgeries.
• Assessing the economic viability of these procedures is crucial for healthcare providers and institutions.

Purpose of the Study:

• To determine the break-even times for secondary IOL procedures (repositioning, insertion, exchange) when performed with PPV.
• To evaluate the profitability of these procedures under current Medicare reimbursement rates for hospitals.
• To identify the economic sustainability of complex secondary IOL surgeries.

Main Methods:

• Retrospective review of 97 secondary IOL procedures with PPV performed in 2023.
• Analysis of Current Procedural Terminology (CPT) billing codes for specific secondary IOL procedures (66825, 66985, 66986).
• Calculation of total operative costs and Medicare reimbursement rates to determine break-even times and net margins.

Main Results:

• The majority of secondary IOL procedures (85.56%) with PPV were unprofitable, with median net losses ranging from -$822.40 to -$3395.04.
• Break-even times for single-surgeon procedures ranged from 75.96 to 77.05 minutes.
• Operative times frequently exceeded break-even times, with a median difference of 13.96 to 46.91 minutes.

Conclusions:

• Current Medicare reimbursement rates are insufficient to cover the costs of secondary IOL procedures performed with PPV.
• Increased reimbursement is necessary for the economic sustainability of these complex ophthalmic procedures.
• Maintaining high standards of care necessitates addressing the financial challenges associated with these surgeries.