Surgical advancements and reimbursement policies may influence treatment decisions and Medicare costs

Several articles published over the last decade have noted changes in the number and types of glaucoma surgical procedures performed in the Medicare population. There has been a consistent drop in the number of trabeculectomies, and an increase in the number of laser trabeculoplasty, cyclophotocoagulation and tube shunt implant procedures performed over the last five years. The current study examines these trends from 1997 through 2006 and correlates them with trends in Medicare payments for glaucoma surgical procedures.

Glaucoma procedures billed to Medicare decreased through 2001, but since then, total surgical procedures have increased even though overall payments per procedure have decreased. The authors also note that even though the percentage decrease in payments for laser trabeculoplasty and cyclophotocoagulation was more than the average decrease per claim, their use increased. The implication is that clinical and technological advancements, as well as reimbursement decisions, including changes in global postoperative periods for laser trabeculoplasty, influence surgeons' preferences and therefore costs to Medicare. As additional new surgical glaucoma procedures are billed to Medicare, it will be important to continue to examine trends in the frequency of specific procedures and how they may be influenced by factors, including reimbursement, postoperative management and clinical advancements.

Financial Disclosures
Dr.Reynolds has no financial interests to disclose.