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

Purpose: To determine the break-even times at which secondary intraocular lens procedures become profitable under current Medicare reimbursement rates for hospitals, when performed with concurrent pars plana vitrectomy (PPV). Methods: The charts of patients who underwent secondary intraocular lens operations with PPV in 2023 were reviewed. Inclusion criteria for patients treated within that timeframe were Current Procedural Terminology billing codes for: (1) secondary intraocular lens repositioning (66825), (2) secondary intraocular lens insertion only (66985), or (3) secondary intraocular lens exchange (66986). Total operative costs and expected Medicare reimbursement rates were calculated for each procedure. Break-even times for profitability per procedure were calculated as the operative time at which maximum Medicare reimbursement equaled the total expected operative costs. Results: Our cohort included 97 secondary intraocular lens procedures performed with PPV. Median operative costs ranged from $6788.93 to $8762.76 for single-surgeon procedures and $8501.96 to $9393.56 for double-surgeon procedures. Break-even times for single-surgeon procedures were: 76.51 minutes for Intraocular lens repositioning with PPV; 77.05 minutes for intraocular lens exchange with PPV; and 75.96 minutes for intraocular lens insertion with PPV. Among all cases, 85.56% were found to be unprofitable and incurred a median net negative margin, ranging from -$822.40 (single-surgeon Intraocular lens repositioning) to -$3395.04 (double-surgeon Intraocular lens exchange). The median difference between total operative time and break-even times ranged from 13.96 minutes (Intraocular lens repositioning) to 46.91 minutes (intraocular lens exchange). Conclusions: The majority of secondary intraocular lens procedures performed with PPV are not profitable under current Medicare reimbursement rates. Increased reimbursement for these complex procedures is required to achieve economic sustainability and maintain quality standards.