Billing of cataract surgery as complex versus routine for Medicare beneficiaries
| Autor: | Fasika A. Woreta, Divya Srikumaran, Sidra Zafar, Oliver D. Schein, Jennifer E. Thorne, Peiqi Wang, Martin A. Makary |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty genetic structures Referral Cross-sectional study Cost-Benefit Analysis medicine.medical_treatment MEDLINE Cataract Extraction Medicare Odds 03 medical and health sciences 0302 clinical medicine Odds Ratio Humans Medicine Aged Retrospective Studies Aged 80 and over business.industry Retrospective cohort study Health Care Costs Odds ratio Middle Aged Cataract surgery United States eye diseases Sensory Systems Confidence interval Ophthalmology Cross-Sectional Studies 030221 ophthalmology & optometry Female Surgery business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Cataract and Refractive Surgery. 45:1547-1554 |
| ISSN: | 0886-3350 |
| DOI: | 10.1016/j.jcrs.2019.06.008 |
| Popis: | Purpose To estimate ophthalmologist-level variation in cataract surgery billing and evaluate patient and ophthalmologist characteristics associated with complex cataract surgery coding. Setting Cross-sectional study. Design Retrospective case series. Methods Medicare beneficiaries aged 65 years or older who had cataract surgery between January 1, 2016, and December 31, 2017, were included. Billing of cataract surgery as complex versus routine and patient and physician characteristics associated with billing of cataract surgery as complex were evaluated. Results An estimated 3.5 million cataract procedures were performed on Medicare beneficiaries in 2016 and 2017. Men (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.75-1.82), patients 75 years or older (versus those aged 65 to 74 years: OR, 1.35; 95% CI, 1.33-1.36), and racial minorities (blacks versus whites: OR, 1.80; 95% CI, 1.75-1.85) had increased odds of having cataract surgery coded as complex. The mean rate of coding for complex cataract surgery by individual surgeons (n = 10 075) in the United States was 11.2%, with significant variation. A high-risk clinical diagnosis code was associated with 40.0% of complex cataract surgeries. Adjusted for patient characteristics, ophthalmologists who graduated from medical school within the past 10 years (OR, 1.35; 95% CI, 1.22-1.49) were more likely to code for complex cataract surgery. Higher volume ophthalmologists were less likely to code for complex cataract surgery than low-volume ophthalmologists. Conclusions There was marked variation among ophthalmologists in the use of complex cataract surgery. Some variability might represent inaccurate coding and was not entirely based on differences in referral patterns for more complex patients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|