In a new investigation published in JAMA Ophthalmology, researchers found that Medicare reimbursement undervalued complex cataract surgery and suggest that an increase in reimbursement for those surgeries requires consideration.
How did they figure this out?
The study was a retrospective examination of cataract surgeries at the University of Michigan Kellogg Eye Center from 2017 to 2021 that calculated the costs of 13,904 simple cataract surgeries and 2,188 complex cataract surgeries. The analysis used Time-Driven Activity-Based Costing (TDABC) and was limited to the day of surgery.
The cost calculations used process flow, time estimates, capacity costs, and material costs. Calculated reimbursement differences were based on Medicare locality and the price lookup tool.
Findings?
The differences between simple and complex cataract surgery were statistically significant when it came to all aspects (anesthesia, 17 minutes; operating room, 16.5 minutes; postoperative care, 3.2 minutes) except for preoperative care.
The mean costs of supplies for complex surgery were greater by $168.65, and the mean costs of total materials were greater by $158.26. Mean total time-based costs had a net difference of $719.59.
What else?
Overall, the study found that complex cataract surgery cost a mean $877.85 more than simple cataract surgery, and is reimbursed by Medicare at an incremental $231.01 compared to simple cataract surgery.
The difference between Medicare reimbursements for complex cataract surgery and the cost of those surgeries is a net negative of $646.84.
What does this mean for patients?
The data suggests that these complex cataract surgeries are undervalued by Medicare reimbursement rates.
The authors suggest that when taken alone, these low rates may result in corporate healthcare entities pushing complex cataract cases elsewhere, resulting in reduced access to care for patients.