An Analysis of Medicare Reimbursement to Ophthalmologists: Years 2012 to 2013.

Journal Article (Journal Article)

Purpose

To analyze trends in utilization and payment of ophthalmic services in the Medicare population for years 2012 and 2013.

Design

Retrospective, cross-sectional study.

Methods

A retrospective cross-sectional observational analysis was performed using publicly available Medicare Physician and Other Supplier aggregate file and the Physician and Other Supplier Public Use File. Variables analyzed included aggregate beneficiary demographics, Medicare payments to ophthalmologists, ophthalmic medical services provided, and the most common Medicare-reimbursed ophthalmic services.

Results

In 2013, total Medicare Part B reimbursement for ophthalmology was $5.8 billion, an increase of 3.6% from the previous year. From 2012 to 2013, the total number of ophthalmology services rendered increased by 2.2%, while average dollar amount reimbursed per ophthalmic service decreased by 5.4%. The top 5 highest reimbursed services accounted for 85% of total ophthalmic Medicare payments in 2013, an 11% increase from 2012. During 2013, drug reimbursement represented 32.8% of the total Medicare payments to ophthalmologists. Ranibizumab and aflibercept alone accounted for 95% of the entire $1.9 billion in drug reimbursements ophthalmologists in 2013.

Conclusion

Medicare Part B reimbursement for ophthalmologists was primarily driven by use of anti-vascular endothelial growth factor (anti-VEGF) injections from 2012 to 2013. Of the total drug payments to ophthalmologists, biologic anti-VEGF agents ranibizumab and aflibercept accounted for 95% of all drug reimbursement. This is in contrast to other specialties, in which drug reimbursement represented only a small portion of Medicare reimbursement.

Full Text

Duke Authors

Cited Authors

  • Han, E; Baisiwala, S; Jain, A; Bundorf, MK; Pershing, S

Published Date

  • October 2017

Published In

Volume / Issue

  • 182 /

Start / End Page

  • 133 - 140

PubMed ID

  • 28784553

Electronic International Standard Serial Number (EISSN)

  • 1879-1891

International Standard Serial Number (ISSN)

  • 0002-9394

Digital Object Identifier (DOI)

  • 10.1016/j.ajo.2017.07.022

Language

  • eng