Medicare-billed laser trabeculoplasty more often performed by optometrists, data show
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Key takeaways:
- In a tristate cohort analysis, Medicare-allowed payments for laser trabeculoplasty decreased from 2015 to 2018 by about 26%.
- Medicare-allowed payments furnished by optometrists increased during that time.
Despite a decrease in total Medicare-allowed payments for laser trabeculoplasty across the U.S. and in three key states from 2015 to 2018, there was an increase in payments by optometrists vs. ophthalmologists, according to research.
“The recent expansion of practice scope for optometrists in select U.S. states marks a significant evolution in the interplay between ophthalmologic and optometric care,” Zain S. Hussain, MD, from the department of ophthalmology at Dean McGee Eye Institute in Oklahoma City, and colleagues wrote in Clinical Ophthalmology. “This study highlights a national shift towards greater optometric involvement in traditional ophthalmic procedures.”
In a retrospective cohort analysis, researchers used the CMS Public Use File from 2015 to 2018 to identify eye care providers who performed laser trabeculoplasty to treat glaucoma in Kentucky, Louisiana and Oklahoma.
Hussain and colleagues found that total Medicare-allowed payments for the procedure billed by ophthalmologists and optometrists nationwide was roughly $25,576,575 in 2018, compared with $41,277,040 in 2015, a 33% decrease. Within Kentucky, Louisiana and Oklahoma, the reduction was 26%, dropping from $1,511,594 in 2015 to $1,107,114 in 2018.
However, the proportion of Medicare-allowed payments furnished by optometrists in this tristate cohort increased from 11.3% in 2015 to 17.9% in 2018, which dropped from 88.7% in 2015 to 82.1% in 2018 for ophthalmologists.
“The recent expansion of surgical authority by optometrists in key U.S. states is creating a tangible impact on ophthalmologic and optometric practice patterns,” Hussain and colleagues wrote. “The findings of this study may act as provision for policymakers in the context of continually evolving guidelines for optometric surgical expansion.”
Perspective
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Nate Lighthizer, OD, FAAO, FAAOMS
Selective laser trabeculoplasty has continued to become more widely adopted by ophthalmology and optometry alike, especially earlier in the course of therapy. The 2022 LiGHT trial data demonstrated that nearly 70% of first-line SLT patients were drop free at the 6-year mark. Further, more eyes in the drop arm (27%) vs. the SLT arm (19.6%) demonstrated glaucoma progression over a 6-year period. These results strengthened the argument that SLT should be used earlier in the course of therapy to ease the compliance burden on patients.
To no surprise then, it is seen that optometry is adopting SLT more and more in states where laser scope expansion has passed, such as Oklahoma, Kentucky and Louisiana. Optometry is the most likely provider to diagnose and treat glaucoma first line, and with SLT gaining widespread acceptance as a first-line treatment option, it makes sense that optometry would be utilizing it more in states where it falls within scope.
I expect this trend to continue over the next 5 to 10 years as more laser states come on board for optometry and SLT continues to gain momentum as the most patient-friendly first-line treatment option. Glaucoma patients often struggle with compliance, and optometry and ophthalmology should continue to look for options to help ease that treatment burden, with SLT being one of the best ways to overcome that burden.
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