Poor reimbursement may discourage simultaneous bilateral cataract surgery

Health care systems in many countries impose financial disincentives for performing simultaneous bilateral cataract surgery, which may account for widespread reluctance among surgeons to perform such procedures, a study suggests.

Steve A. Arshinoff, MD, examined health care reimbursement systems in Canada, the United States, Japan, Israel, Australia and the United Kingdom and compared the financial rewards for bilateral cataract surgery vs. sequential unilateral procedures.

He and coauthor Sylvia H. Chen noted that operating on both of a patient's eyes during the same session enables a surgeon to perform about 15% more surgeries per day. However, this potential benefit is nullified by poor or nonexistent reimbursement for bilateral procedures in most of the health care systems reviewed, they noted.

"Every province in Canada imposes financial restrictions or disincentives on surgeons to discourage them from performing simultaneous bilateral cataract surgery," the study authors said.

In Canada, reimbursement for same-day second-eye surgeries ranged from 50% of the first-eye rate in British Columbia and Quebec to 85% in Ontario. As might be expected, surgeons in Ontario perform simultaneous bilateral procedures most often, the authors said, although even there they are restricted; anesthesiologists receive 65% of the fee for unilateral surgery for the second eye.

In the United States, ophthalmologists receive 50% of the Medicare payment for a unilateral procedure for concurrently operating on a patient's contralateral eye, according to the study.

Surgeons in the United Kingdom are reimbursed 80% of the first-eye rate for performing same-day second-eye surgeries. The increased efficiency afforded by simultaneous procedures helps offset the reduced reimbursement, allowing U.K. surgeons to profit from doing simultaneous bilateral procedures, the study authors said.

Not surprisingly, "Simultaneous bilateral cataract surgery was more popular in the U.K. than in any other jurisdiction surveyed," the authors said.

Ophthalmologists in Japan and Israel do not receive reimbursement for same-day second-eye surgeries, they noted.

The study is published in the August 2006 issue of the Journal of Cataract & Refractive Surgery.