Medicare Payment to Service Volume Elasticities for Glaucoma Procedures From 2013 to 2021

Glaucoma is a leading cause of irreversible blindness, and Medicare payments influence access to and utilization of glaucoma procedures. This study examines the relationship between Medicare payments and service volumes for glaucoma procedures.

This retrospective longitudinal study used Medicare Part B National Summary Data Files from the Centers for Medicare and Medicaid Services (CMS). Data for glaucoma procedures from 2013 to 2021 with at least five years of available data were analyzed. The dataset included service volumes, average payments, total practicing ophthalmologists, and Medicare Part B beneficiary trends across the United States. The relationship between Medicare payments and service volumes was quantified using payment-volume elasticities, calculated as the percentage change in procedural volume per 1% change in Medicare reimbursement.

Twenty procedures were evaluated. Minimally invasive glaucoma surgeries (MIGS) exhibited the greatest sensitivity, with a payment-volume elasticity of 4.67% (p < 0.001): for every 1% increase in payment, MIGS volume increased by 4.67%. Traditional Glaucoma Surgeries (TGS) had a payment-volume elasticity of 1.96% (p = 0.002), with a 1% decrease in payment resulting in a 1.96% decrease in TGS volume. Specific procedures like goniotomy (CPT: 65820) and aqueous drainage device (CPT: 66183) also showed significant elasticities of 4.27% and 4.13%, respectively.

A significant relationship between Medicare payment adjustments and the utilization of glaucoma procedures was observed, with potential implications for access and care delivery. MIGS demonstrated the highest sensitivity to payment changes, suggesting that reimbursement policies could influence the adoption and availability of these surgeries beyond clinical decision-making.