James C. Tsai, M.D., M.B.A.
President – New York Eye and Ear Infirmary of Mount Sinai
Delafield-Rodgers Professor and Chair Department of Ophthalmology Icahn School of Medicine at Mount Sinai
Medical Research: What is the background for this study? What are the main findings?
- Congress first introduced the Medicare Physician Fee Schedule built on the resource-based relative value scale (RBRVS) in the Omnibus Budget Reconciliation Act of 1989. Until recently, Medicare payments to physicians were adjusted annually based on the sustainable growth rate (SGR) formula.
- When adjusting physician payments, one controversial belief by policymakers was the assumption that in response to fee reductions, physicians would recuperate one-half of lost revenue by increasing the volume and complexity of services.
- This study questioned this assumption that this inverse relationship between Medicare payment and procedural volume is uniform across all procedures. In particular, glaucoma procedures have not been studied in the past.
- Using a fixed effects regression model, we found that for six commonly performed glaucoma procedures, four did not have any significant Medicare payment and procedural volume relationship (laser trabeculoplasty, trabeculectomy with and without previous surgery, aqueous shunt to reservoir). Two procedures, laser iridotomy and scleral reinforcement with graft, did have significant and inverse associations between Medicare payment and procedural volume.
Medical Research: What should clinicians and patients take away from your report?
- Our research suggests that for many glaucoma procedures, decreased payment does not lead ophthalmologists to compensate by performing more procedures.
- More broadly speaking, it is incorrect to assume that one number can adequately and accurately describe how physicians respond to Medicare payment changes
Medical Research: What recommendations do you have for future research as a result of this study?
- The relationship between Medicare payment and procedural volume is complex, requiring a more nuanced perspective that takes into account individual procedural and specialty variation.
- To more accurately project future Medicare spending, more research is necessary to study how physicians respond to changes in both Medicare payment rates and payment models.
MedicalResearch.com Interview with: Dan Gong BA, & Icahn School of Medicine at Mount Sinai (2015). Decreased Medicare Payment Did Not Mean Increased Volume For Most Glaucoma Procedures