Costs of Preoperative Testing for Patients With Cataract
JAMA Ophthalmology, March 2018
The 30-day window preceding cataract surgery is commonly used to study costs of preoperative testing. Chen et al. sought to estimate the full cost of preoperative testing by including all tests conducted after a cataract surgery is scheduled. They found that many tests are performed before the 30-day preoperative window, resulting in overall testing costs that are higher than previously reported.
For their cross-sectional study, the authors utilized a 50% sample of Medicare beneficiaries (> 66 years of age) who underwent ambulatory cataract surgery in 2011. The surgery date was defined as the first day that a claim for routine cataract surgery was submitted by an ophthalmologist. Only the cataract surgery on the first eye (index surgery) was included. Tests that occurred between the first biometry claim and the index surgery were considered routine. Testing rates were determined for the interval between ocular biometry and cataract surgery and for the 6 months preceding biometry.
Of the 440,857 patients who underwent cataract surgery in 2011, those with a claim for ocular biometry before index surgery (n = 423,710) constituted the study population. Of these, 6.3% had a biometry claim submitted on the day of surgery, 25.4% underwent surgery more than 30 days after biometry, and 5.1% had surgery more than 90 days after biometry.
The mean number of tests per patient per month increased from 1.1 in the baseline period (≤ 6 months before biometry) to 1.7 in the interval between biometry and cataract surgery. Although the frequency of preoperative testing peaked for all patients in the 30-day preoperative window (1.8 tests/patient/month), the subset of patients with no time overlap between the postbiometry and presurgery periods had a higher testing rate during the 30 days after biometry (1.8 tests/patient/month), regardless of the amount of time between biometry and surgery.
The total estimated cost of routine preoperative testing in this study was $22.7 million, for an estimated annual cost burden for Medicare of up to $45.4 million. As a cost-cutting measure, the authors suggested avoiding routine tests between biometry and surgery. (Also see related commentary by Farhan I. Merali, MD, MBA, and Oliver D. Schein, MD, MPH, MBA, in the same issue.)
The original article can be found here.