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Cataract Surgery Rates Tied to Physician Reimbursement

Payment for each procedure results in more surgeries, new study finds

TUESDAY, Dec. 13, 2005 (HealthDay News) -- A fee-for-service approach is associated with a much higher rate of cataract surgery and related surgical costs, compared to a system that pays doctors a lump sum for each patient they manage -- called contact capitation, a new U.S. study says.

Under fee-for-service, doctors are paid for each procedure they perform.

In this study, researchers analyzed data for more than 90,000 commercial beneficiaries and more than 14,000 Medicare beneficiaries who received eye care from a network of ophthalmologists and optometrists in St. Louis between 1997 and 1998.

"Compared with fee-for-service, contact capitation reimbursement was associated with significant decreases in cataract extraction rates and costs," the study authors wrote.

"Both commercial and Medicare beneficiaries were approximately one half as likely to have cataract extraction under contact capitation as compared with fee-for-service. Professional reimbursement increased by 8 percent whereas facility fees for cataract procedures decreased by approximately 45 percent," the authors wrote.

They also concluded that after implementation of contact capitation, cataract surgical rates decreased more dramatically than any other ophthalmologic procedures.

The study appears in the December issue of the Archives of Ophthalmology.

"Cataract surgery is almost always an elective procedure, can be performed quickly with few complications, and the exact timing of surgery is subject to both the surgeon's judgment and influence," the authors wrote.

"The finding that cataract surgery was more responsive to reimbursement methodology than other procedures supports the hypothesis that elective procedures are more responsive to physician incentives than non-elective procedures."

More information

The U.S. National Eye Institute has more about cataracts.

SOURCE: JAMA/Archives journals, news release, Dec. 12, 2005
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