Related Experiment Videos
Comparing National Microinvasive Glaucoma Surgery Procedure Rates in Response to Medicare and Industry Payment
Yash Gulani1, Gerard F Anderson2, Thomas V Johnson3
1Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ophthalmology. Glaucoma
|June 19, 2026
Summary
A significant Medicare payment cut for trabecular stents led to a 33% decrease in their use, with ophthalmologists shifting to alternative microinvasive glaucoma surgery (MIGS) procedures. Industry payments did not influence this shift, highlighting Medicare policy
Area of Science:
- Ophthalmology and Health Economics
- Glaucoma Surgery and Payment Policy Analysis
Background:
- Microinvasive glaucoma surgery (MIGS) offers alternatives to traditional glaucoma procedures.
- Understanding the impact of financial incentives on surgical practice patterns is crucial for healthcare policy.
Purpose of the Study:
- To investigate the association between changes in Medicare payments and industry transfers of value (TOVs) on microinvasive glaucoma surgery (MIGS) procedure rates.
- To determine the relative influence of Medicare reimbursement versus industry payments on ophthalmologists' procedural choices.
Main Methods:
- Retrospective observational cohort study analyzing Medicare Part B claims (2018-2023).
- Examined trabecular meshwork bypass stent implantation, goniotomy, and canaloplasty utilization.
- Assessed the impact of Medicare payment changes for trabecular stents (implemented Jan 2022) and contemporaneous industry TOV payments.
Main Results:
- A Medicare payment reduction for trabecular stents (approx. $500 to $34) correlated with a 33% decline in their utilization.
- Goniotomy utilization increased by 61% and canaloplasty by 19% following the payment change.
- Increased industry TOV payments in 2022 did not offset the decline in trabecular stent use, even among high recipients.
Conclusions:
- Medicare payment policy significantly influenced procedural selection for MIGS, overriding industry financial incentives.
- Reduced Medicare payments for trabecular stents led to increased adoption of alternative MIGS procedures.
- Surgical practice patterns are highly sensitive to substantial changes in reimbursement rates.
Related Concept Videos
01:25Glaucoma: Overview
Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
01:27Open Angle Glaucoma: Treatment
In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
Drugs such as carbonic anhydrase inhibitors, α2- and...
Drugs such as carbonic anhydrase inhibitors, α2- and...
01:28Angle Closure Glaucoma: Treatment
Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...