Access to Laser Capsulotomy in Oklahoma: Ophthalmologists and Optometrists
Ophthalmology, September 2017
Access to eye care in rural areas is presented as justification for expanding the responsibilities of optometrists to include laser procedures in some states. In Oklahoma, laser privileges were granted to these providers in 1998, including Nd:YAG posterior capsulotomy. Mahr et al. calculated the proximity of Medicare beneficiaries to their capsulotomy provider and found no meaningful geographic difference between optometrists and ophthalmologists.
Oklahoma Medicare data sets (100% and 5%) for 2014 were used in the cross-sectional study, along with travel distances and approximate driving times generated from a Google Maps programming interface. The shortest travel distance and associated driving time from the patient’s residence to his or her laser provider were documented.
In 2014, 90 (57%) of 157 Oklahoma ophthalmologists submitted a total of 7,521 claims to Medicare for Nd:YAG laser capsulotomy. During this same period, 65 (13%) of the 506 Oklahoma optometrists submitted a total of 3,751 claims for the procedure. Six (9%) of the 65 optometrists shared their office address with an ophthalmologist. Seven ophthalmologists and 15 optometrists had a secondary location.
Analysis of the Medicare Limited 5% data set showed no meaningful difference in driving distance between beneficiaries who received laser capsulotomy from an ophthalmologist (median, 39 miles) and those who received it from an optometrist (median, 46 miles). Similarly, the driving time to an ophthalmologist (median, 47 minutes) was comparable to that for an optometrist (median, 50 minutes). If the beneficiary did not receive the Nd:YAG laser capsulotomy from his or her current optometrist, the additional travel distance to the closest laser-providing ophthalmologist’s office from the laser-providing optometrist’s office was a median of 2 miles (interquartile range, 1-26 miles; mean, 17 ± 29 miles).
The original article can be found here.