Study: Cataract surgery rate dropped under capitation

Under a capitated reimbursement system, the rate and the cost of cataract surgery decreased in comparison with a fee-for-service arrangement, according to a study. The frequency of cataract surgery was more responsive to physician financial incentives than other ophthalmologic procedures, the study found.

William Shrank, MD, MSHS, and colleagues examined the claims of more than 91,000 commercial insurance beneficiaries and 14,000 Medicare beneficiaries in St. Louis from 1997 to 1998 from a network of ophthalmologists and optometrists. The researchers compared the rate of cataract extractions per 1,000 beneficiaries, the cost of cataract procedures, the rates of noncataract procedures and the amount of professional reimbursement for providers during the final 6 months of a fee-for-service physician reimbursement arrangement and the first 6 months of contact capitation.

Both commercial and Medicare beneficiaries were about half as likely to have cataract extraction under contact capitation as under fee-for-service. Professional reimbursement increased by 8%, and facility fees for cataract procedures decreased by 45%. Cataract surgical rates were disproportionately affected when compared with other ophthalmologic procedures, the study authors found.

The study is published in the December issue of Archives of Ophthalmology.