Medicare Payments for Glaucoma Procedures Dropping Even Though Number of Procedures Has Been Increasing

July 17, 2009

According to a report in the July issue of the Archives of Ophthalmology, while the overall annual number of glaucoma procedures has been growing, payments by Medicare for glaucoma procedures has been decreasing. The drop in total payments for surgical procedures was attributed to a shift to lower-cost procedures.

The report relied on a retrospective study of Part B Medicare data for 100,000 beneficiaries from 1997 to 2006. Researchers found the most common surgical treatments for glaucoma include laser trabeculoplasty, filtering surgery, tube shunt surgery and cyclodestructive procedures.

Overall, there were decreases noted in both the number of glaucoma surgical procedures and the amount of annual Medicare payments from 1997 to 2001, but there was an increase in the number of procedures in the following years. In particular, after an initial decline, the number of trabeculoplasties increased. However, Medicare payments for trabeculectomies decreased over time, while annual payments for newer procedures, such as cyclophotocoagulation and shunt-related procedures, increased.

Limitations on the studies include that it examined only fees paid directly to physicians, and of course, does not include data on patients between 40 to 64 who are not covered by Medicare.

This study brings up several interesting, thought-provoking points: why is there a trend for more trabeculoplasties? How will this trend impact national glaucoma expenditures? With the changes in health care that are being discussed, these types of questions should be looked at by ophthalmologists so we can participate in the discussion and continue to provide quality care for our patients.

Read the abstract and full article here (log in required).




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2 Responses to “Medicare Payments for Glaucoma Procedures Dropping Even Though Number of Procedures Has Been Increasing”

  • Dr. Ari Weitzner

    unethical doc will do more alt’s, but ethical ones do as well- many patients don’t have drug coverage or simply are not compliant. i am relieved not to do trabs- hate ’em! i am pleased that phaco plus 1 or 2 meds or alt control 95% of my patients. looking forward to more ab interno procedures like trabecutome to put the nail in the trab coffin.

  • There can be a few reasons for this shift to the ‘lower cost’ trabeculoplasties that comes to mind. Although never really proven that the SLT is more effective than the ALT for treating glaucoma, the device has certainly popularized the procedure. I suspect this means that more patients are receiving an SLT earlier in the course of their disease, eg as primary therapy or after one drop has been started. Had we been doing ALT that early on, we would probably have seen the same favorable results. A second reason for the increase in trabeculoplasties can be that physicians get paid to do this whereas they don’t get paid for every bottle of meds we put our patients on; that being said, we hope that this does not bias us in our treatment of patients with glaucoma and that we really feel that early SLT is best for our patients.

    With fewer meds likely being prescribed, we are also probably sparing the conjunctiva for later so that less expensive glaucoma surgical interventions are more likely to be effective without having to resort to tube-shunts. (Very scary that a horribly flawed study such as the trab vs tube study suggested that tubes should be done primarily – but that is a whole other topic for debate.)