Evaluating Metrics Assessing Surgical Success in Patients Undergoing Cataract Surgery

Area of Science:

• Ophthalmology
• Health Services Research
• Public Health

Background:

• Health insurers and policymakers use Merit-Based Incentive Payment System (MIPS) measures to evaluate eye care quality and surgeon performance.
• Understanding the validity and generalizability of these MIPS metrics is crucial for accurate assessments and reimbursement decisions.

Purpose of the Study:

• To assess the validity and generalizability of the 2024 MIPS measure 191, specifically "Cataracts: 20/40 or Better Visual Acuity Within 90 Days Following Cataract Surgery."
• To determine factors associated with achieving the MIPS measure 191 success criteria after cataract surgery.

Main Methods:

• Retrospective cohort study of 55,132 patients undergoing cataract surgery across 16 health systems from 2010-2023.
• Logistic regression models analyzed associations between patient demographics, clinical factors, and achieving a best-corrected visual acuity of 20/40 or better within 90 days.
• Success rates were evaluated overall and excluding patients with pre-existing chronic ocular diseases.

Main Results:

• Overall, 90.7% of patients achieved surgical success. Excluding patients with ocular comorbidities, 95.5% achieved success.
• Factors associated with lower odds of success included living in less affluent communities, undergoing complex or combined intraocular surgery, and having diabetes.
• The MIPS measure excluded 46.4% of patients due to ocular comorbidities, with older and Black patients being more likely to be excluded.

Conclusions:

• Most patients meet the MIPS measure 191 criteria for cataract surgery success.
• The measure's exclusion criteria disproportionately affect certain patient groups, potentially impacting fairness in performance comparisons.
• Case-mix adjustment considering sociodemographic and clinical factors may be essential for equitable surgeon performance evaluation.