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No association seen between Medicare payments, service volumes for highly used retina procedures
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There was no association between Medicare payments and service volume for three high-volume retina procedures between 2005 and 2009, according to a study.
The retrospective, longitudinal database study provided a quantitative analysis of all retina procedures performed on Medicare Part B beneficiaries to calculate the relationship between Medicare payment and service volume for intravitreal injections, laser treatment for retinal edema and laser treatment for proliferative retinopathy.
Over the 5-year period, average payments fell 20.7% for intravitreal injections, 13% for laser treatment for retinal edema and 5.8% for laser treatment for proliferative retinopathy.
Total service volume decreased by 13.5% for laser treatment for retinal edema and 10.4% for laser treatment for proliferative retinopathy, but total service volume more than quadrupled for intravitreal injections.
Medicare payment-service volume elasticities, described as the percent change in Medicare service volume per 1% change in Medicare payment, were –0.75 for intravitreal injections, 0.14 for laser treatment for retinal edema and 0.05 for laser treatment for proliferative retinopathy. The elasticity for intravitreal injections was statistically significant (P = .09).
“These findings differ from early [Health Care Financing Administration] studies and raise the importance of conducting updated research on the relationship between Medicare payment and service volume,” the study authors said. “In addition, the discrepant findings across multiple studies and procedures suggest that different procedures may have varying elasticities with respect to payment and service volume.” – by Kristie L. Kahl
Disclosure: The authors report no relevant financial disclosures.
Perspective
Back to TopJohn B. Pinto
For the last 40 years as a consultant and "ophthalmologistologist," I've had an opportunity to observe in the field surgeons' behavioral responses to various inputs, albeit with much less statistical rigor than Dr. Gong et al.
It’s clear that surgeons tend to reduce their overall production under some circumstances: when they have been audited by payers for over-utilization; when they are about to divorce and need to demonstrate a lower income; or when a surgical misadventure makes them rethink, for a time, their care pathways. And it’s also clear that surgeons tend to increase their overall production in other circumstances: when they get married or start a new family, and financial pressures mount; when they become aware of rising practice costs or competitor encroachment or when they take on expensive new hobbies.
However, my observation through the years is that with a few rare, sociopathic exceptions, eye surgeons do not increase or decrease their utilization based on payment levels, even under capitation, which is the ultimate incentive to undertreat. Generally speaking, when tests and procedures are effective, help patients, and deliver to the provider a sense of professional satisfaction, they are employed as clinically indicated--no more and no less.
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Gong D, et al. Ophthalmology. 2015;doi:10.1016/j.ophtha.2015.04.040.
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