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Trends in Medicare Service Volume for Cataract Surgery and the Impact of the Medicare Physician Fee Schedule
Author(s) -
Gong Dan,
Jun Lin,
Tsai James C.
Publication year - 2017
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12535
Subject(s) - medicine , fee for service , medicare part b , payment , cataract surgery , service (business) , retrospective cohort study , family medicine , actuarial science , finance , ophthalmology , business , health care , economics , marketing , economic growth
Objective To calculate the associations between Medicare payment and service volume for complex and noncomplex cataract surgeries. Data Sources The 2005–2009 CMS Part B National Summary Data Files, CMS Part B Carrier Summary Data Files, and the Medicare Physician Fee Schedule. Study Design Conducting a retrospective, longitudinal analysis using a fixed‐effects model of Medicare Part B carriers representing all 50 states and the District of Columbia from 2005 to 2009, we calculated the Medicare payment–service volume elasticities for noncomplex ( CPT 66984) and complex ( CPT 66982) cataract surgeries. Data Extraction Service volume data were extracted from the CMS Part B National Summary and Carrier Summary Data Files. Payment data were extracted from the Medicare Physician Fee Schedule. Principal Findings From 2005 to 2009, the proportion of total cataract services billed as complex increased from 3.2 to 6.7 percent. Every 1 percent decrease in Medicare payment was associated with a nonsignificant change in noncomplex cataract service volume (elasticity = 0.15, 95 percent CI [−0.09, 0.38]) but a statistically significant increase in complex cataract service volume (elasticity = −1.12, 95 percent CI [−1.60, −0.63]). Conclusions Reduced Medicare payment was associated with a significant increase in complex cataract service volume but not in noncomplex cataract service volume, resulting in a shift toward performing a greater proportion of complex cataract surgeries from 2005 to 2009.