Patients come first even as reimbursement decreases for vitreoretinal procedures
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KOLOA, Hawaii — Despite decreases in reimbursement for vitreoretinal procedures, surgeons should still prioritize doing what is best for the patient, according to a speaker at Retina 2023.
Adrienne W. Scott, MD, FASRS, said when surgeons dig into the costs of the procedures they perform, it is easy to wonder what is going on with reimbursement and the economics of vitreoretinal surgery.
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“There’s an increase in our Medicare population,” she said. “We know our patients are living longer. They’re getting these diseases and have a longer need for treatment for these chronic diseases.”
Scott said research has shown a sixfold increase in vitreoretinal procedures from 2000 to 2014. However, from 2000 to 2020, reimbursement is down 25.4%, a decrease of 1.3% per year.
An analysis showed that routine vitrectomy costs about $7,200 per patient, which Scott said is about $2,000 more than the maximum Medicare reimbursement for an equivalent episode. In order for vitrectomy cases to break even, Scott said they need to be completed in less than 26.81 minutes, overhead needs to be reduced by 53.78%, or reimbursement needs to be increased by 40.15%.
“This seems somewhat untenable to meet these metrics,” Scott said.
To balance patient care with economics, Scott said surgeons need to be flexible, thoughtful and innovative.
“Sometimes we go for the kitchen sink approach and say, ‘I’ll figure out what I need when I want it,’” she said. “But being thoughtful about these things is sometimes the best way to cost contain.”
Scott said that Americans across all demographics value their vision, and physicians need to repeat these values to payers and people who make payment decisions to ensure patients get the care they need.
“If you do what’s best for the patient, I think that’s the right answer,” Scott said. “But all the while, we have to be aware of increasing costs and decreasing reimbursements.”
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Scott AW. Economics of vitreoretinal surgery. Presented at: Retina 2023; Jan. 15-20, 2023; Koloa, Hawaii.
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