Unnecessary Routine Preoperative Cataract Testing Costs Medicare Millions

MedicalResearch.com Interview with:
Catherine L. Chen, MD, MPH

Assistant Professor
UCSF Department of Anesthesia & Perioperative Care

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Routine preoperative medical testing (such as common laboratory tests looking at a patient’s blood cell counts and kidney function, or cardiac tests like an EKG) are not recommended in patients undergoing cataract surgery, but these tests still occur quite frequently among Medicare cataract surgery patients because these patients tend to be older and sicker than the general population. In the past, researchers have used a 30-day window counting backwards from the date of surgery to determine whether a given test should be categorized as a routine preoperative test. However, we know that testing often takes place outside this window and therefore, the frequency and cost of routine preoperative medical testing has generally been underreported.

In our study, we used a new method to figure out how to determine the start of the routine preoperative testing period. In cataract patients, ocular biometry is a diagnostic test that is performed in anticipation of cataract surgery, and this test is only performed in cataract patients who will be having cataract surgery in the near future. For each patient, we calculated the elapsed time between the ocular biometry and cataract surgery dates to get a better idea of when to start looking for unnecessary routine preoperative testing. Our goal was to identify all the routine preoperative medical testing that occurs once the decision has been made to operate and better estimate the cost to Medicare of this unnecessary testing.

In a previous study that we published in the New England Journal of Medicine, we reported a significant spike in the rate of routine preoperative medical testing that occurs in the 30 days before surgery compared to the baseline rate of testing. In our current study, we discovered that there is a second spike in testing that occurs in the 30 days after ocular biometry. In fact, even if you exclude the testing that takes place during the 30 days before surgery, there is still a 41% increase in testing rates during the interval between ocular biometry and cataract surgery over the baseline rate of testing. In addition, we found that the cost of routine preoperative testing was 47% higher when looking at the entire biometry to surgery timeframe compared to testing that occurs just in the 30 days before surgery.

We estimate that the cost to Medicare of all of this unnecessary testing approaches $45.4 million annually.

MedicalResearch.com: What should readers take away from your report? 

Response: Routine preoperative medical testing often starts the moment a patient is scheduled for cataract surgery. Because they are not recommended for patients undergoing cataract surgery, these tests end up costing Medicare a lot of money with very little benefit to patients. If these tests are being ordered because you are scheduled for cataract surgery, but you are in your usual state of health and there is no other clinical reason for undergoing testing, you should ask your doctor whether you really need these additional tests. In patients who have no new active health problems, cataract surgery is safe without undergoing these additional tests. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We would like to continue to study the relationship between routine preoperative testing and  the timing of surgery, not just in cataract surgery patients, but potentially expanding to other types of surgical procedures. 

MedicalResearch.com: Is there anything else you would like to add? 

Response: Thank you for giving me the opportunity to share my research with a broader audience. I have no conflicts of interest to disclose. 

Citations:

 Chen CL, Clay TH, McLeod S, Chang HP, Gelb AW, Dudley RA. A Revised Estimate of Costs Associated With Routine Preoperative Testing in Medicare Cataract Patients With a Procedure-Specific Indicator. JAMA Ophthalmol. Published online January 18, 2018. doi:10.1001/jamaophthalmol.2017.6372

 

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