Medicare payments for major eye disease decreased during the 1990s

Medicare payments for four major eye diseases decreased during the second half of the 1990s despite an increase in their prevalence, a cost analysis study found. The decrease in Medicare payments was due mainly to reduced reimbursement for cataract surgery procedures in the later years of the review, the study authors said.

Martin Salm, MA, and colleagues at Duke University’s Center for Health Policy estimated the annual Medicare payments made between 1991 and 2000 for patients with cataracts, age-related macular degeneration, diabetic retinopathy and glaucoma. They then compared annual payments made between 1991 and 1995 to those made between 1996 and 2000.

The four eye diseases accounted for roughly 4% of all Medicare claims. The researchers estimated total annual Medicare payments of $6.7 billion between 1996 and 2000, down from $7.4 billion between 1991 and 1995 despite increases in prevalence of all four diseases throughout the decade.

“This largely reflects reductions in Medicare reimbursement rates for cataract care,” the authors explained. Medicare payments for cataract surgery decreased from $6.1 billion during the first half of the decade to $4.8 billion during the second half.

In contrast, payments for AMD rose during the period.

Medicare spending per person within the first year of diagnosis was highest for diabetic retinopathy, and it decreased during the second half of the decade. Payments for glaucoma treatment remained fairly constant throughout the decade. Medicare did not cover prescription drug costs in the time period studied, the authors noted.

The study is published in the December issue of the American Journal of Ophthalmology.