Cataract Surgery in the Medicare Merit-Based Incentive Payment System
Objective: To characterize the development and performance of a cataract surgery episode-based cost measure for the Medicare Quality Payment Program. Design: Claims-based analysis. Participants: Medicare clinicians with cataract surgery claims between June 1, 2016, and May 31, 2017. Methods: We limi...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Ophthalmology Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666914523000477 |
| _version_ | 1797377859041361920 |
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| author | Suzann Pershing, MD, MS Alexander T. Sandhu, MD, MS Aimée-Sandrine Uwilingiyimana, MA David B. Glasser, MD Andrew S. Morgenstern, OD Rose Do, MD Nirmal Choradia, MD Eugene Lin, MD, MS Jasmine Leoung, MPH Miten Shah, MS Ashley Liu, BA, BS Jongwon Lee, MS Amanda Fairchild, MPH Joyce Lam, MPP Thomas E. MaCurdy, PhD Sriniketh Nagavarapu, PhD Jay Bhattacharya, MD, PhD |
| author_facet | Suzann Pershing, MD, MS Alexander T. Sandhu, MD, MS Aimée-Sandrine Uwilingiyimana, MA David B. Glasser, MD Andrew S. Morgenstern, OD Rose Do, MD Nirmal Choradia, MD Eugene Lin, MD, MS Jasmine Leoung, MPH Miten Shah, MS Ashley Liu, BA, BS Jongwon Lee, MS Amanda Fairchild, MPH Joyce Lam, MPP Thomas E. MaCurdy, PhD Sriniketh Nagavarapu, PhD Jay Bhattacharya, MD, PhD |
| author_sort | Suzann Pershing, MD, MS |
| collection | DOAJ |
| description | Objective: To characterize the development and performance of a cataract surgery episode-based cost measure for the Medicare Quality Payment Program. Design: Claims-based analysis. Participants: Medicare clinicians with cataract surgery claims between June 1, 2016, and May 31, 2017. Methods: We limited the analysis to claims with procedure code 66984 (routine cataract surgery), excluding cases with relevant ocular comorbidities. We divided episodes into subgroups by surgery location (Ambulatory Surgery Center [ASC] or Hospital Outpatient Department [HOPD]) and laterality (bilateral when surgeries were within 30 days apart). For the episode-based cost measure, we calculated costs occurring between 60 days before surgery and 90 days after surgery, limited to services identified by an expert committee as related to cataract surgery and under the influence of the cataract surgeon. We attributed costs to the clinician submitting the cataract surgery claim, categorized costs into clinical themes, and calculated episode cost distribution, reliability in detecting clinician-dependent cost variation, and costs with versus without complications. We compared episode-based cost scores with hypothetical “nonselective” cost scores (total Medicare beneficiary costs between 60 days before surgery and 90 days after surgery). Main Outcome Measures: Episode costs with and without complications, clinician-dependent variation (proportion of total cost variance), and proportion of costs from cataract surgery-related clinical themes. Results: We identified 583 356 cataract surgery episodes attributed to 10 790 clinicians and 8189 with ≥ 10 episodes during the measurement period. Most surgeries were performed in an ASC (71%) and unilateral (66%). The mean episode cost was $2876. The HOPD surgeries had higher costs; geography and episodes per clinician did not substantially affect costs. The proportion of cost variation from clinician-dependent factors was higher in episode-based compared with nonselective cost measures (94% vs. 39%), and cataract surgery-related clinical themes represented a higher proportion of total costs for episode-based measures. Episodes with complications had higher costs than episodes without complications ($3738 vs. $2276). Conclusions: The cataract surgery episode-based cost measure performs better than a comparable nonselective measure based on cost distribution, clinician-dependent variance, association with cataract surgery-related clinical themes, and quality alignment (higher costs in episodes with complications). Cost measure maintenance and refinement will be important to maintain clinical validity and reliability. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. |
| first_indexed | 2024-03-08T19:58:26Z |
| format | Article |
| id | doaj.art-ade440a4153e40e7a443e3442c76b99b |
| institution | Directory Open Access Journal |
| issn | 2666-9145 |
| language | English |
| last_indexed | 2024-03-08T19:58:26Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Ophthalmology Science |
| spelling | doaj.art-ade440a4153e40e7a443e3442c76b99b2023-12-24T04:46:58ZengElsevierOphthalmology Science2666-91452023-12-0134100315Cataract Surgery in the Medicare Merit-Based Incentive Payment SystemSuzann Pershing, MD, MS0Alexander T. Sandhu, MD, MS1Aimée-Sandrine Uwilingiyimana, MA2David B. Glasser, MD3Andrew S. Morgenstern, OD4Rose Do, MD5Nirmal Choradia, MD6Eugene Lin, MD, MS7Jasmine Leoung, MPH8Miten Shah, MS9Ashley Liu, BA, BS10Jongwon Lee, MS11Amanda Fairchild, MPH12Joyce Lam, MPP13Thomas E. MaCurdy, PhD14Sriniketh Nagavarapu, PhD15Jay Bhattacharya, MD, PhD16Acumen LLC, Burlingame, California; Byers Eye Institute, Department of Ophthalmology, Stanford University Medical Center, Palo Alto, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Correspondence: Suzann Pershing, MD, MS, Acumen LLC, 500 Airport Blvd., Burlingame, CA 94010.Acumen LLC, Burlingame, California; Stanford Division of Cardiovascular Medicine, Department of Medicine, Stanford, CaliforniaAcumen LLC, Burlingame, CaliforniaAmerican Academy of Ophthalmology, San Francisco, California; Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Ophthalmology and Visual Sciences, University of Maryland, Baltimore, MarylandAmerican Optometric Association, St. Louis, MissouriAcumen LLC, Burlingame, California; Division of Cardiology, Department of Medicine, UC Irvine, Irvine, California; Veterans Affairs Long Beach Health Care System, Long Beach, CaliforniaAcumen LLC, Burlingame, CaliforniaAcumen LLC, Burlingame, California; Medicine and Health Policy and Management, Keck School of Medicine, University of Southern California, Los Angeles, CaliforniaAcumen LLC, Burlingame, CaliforniaAcumen LLC, Burlingame, CaliforniaAcumen LLC, Burlingame, CaliforniaAcumen LLC, Burlingame, CaliforniaAcumen LLC, Burlingame, CaliforniaAcumen LLC, Burlingame, CaliforniaAcumen LLC, Burlingame, California; Department of Economics, Stanford University, CaliforniaAcumen LLC, Burlingame, CaliforniaAcumen LLC, Burlingame, California; Center for Health Policy/Primary Care and Outcomes Research, Department of Medicine, Stanford University, CaliforniaObjective: To characterize the development and performance of a cataract surgery episode-based cost measure for the Medicare Quality Payment Program. Design: Claims-based analysis. Participants: Medicare clinicians with cataract surgery claims between June 1, 2016, and May 31, 2017. Methods: We limited the analysis to claims with procedure code 66984 (routine cataract surgery), excluding cases with relevant ocular comorbidities. We divided episodes into subgroups by surgery location (Ambulatory Surgery Center [ASC] or Hospital Outpatient Department [HOPD]) and laterality (bilateral when surgeries were within 30 days apart). For the episode-based cost measure, we calculated costs occurring between 60 days before surgery and 90 days after surgery, limited to services identified by an expert committee as related to cataract surgery and under the influence of the cataract surgeon. We attributed costs to the clinician submitting the cataract surgery claim, categorized costs into clinical themes, and calculated episode cost distribution, reliability in detecting clinician-dependent cost variation, and costs with versus without complications. We compared episode-based cost scores with hypothetical “nonselective” cost scores (total Medicare beneficiary costs between 60 days before surgery and 90 days after surgery). Main Outcome Measures: Episode costs with and without complications, clinician-dependent variation (proportion of total cost variance), and proportion of costs from cataract surgery-related clinical themes. Results: We identified 583 356 cataract surgery episodes attributed to 10 790 clinicians and 8189 with ≥ 10 episodes during the measurement period. Most surgeries were performed in an ASC (71%) and unilateral (66%). The mean episode cost was $2876. The HOPD surgeries had higher costs; geography and episodes per clinician did not substantially affect costs. The proportion of cost variation from clinician-dependent factors was higher in episode-based compared with nonselective cost measures (94% vs. 39%), and cataract surgery-related clinical themes represented a higher proportion of total costs for episode-based measures. Episodes with complications had higher costs than episodes without complications ($3738 vs. $2276). Conclusions: The cataract surgery episode-based cost measure performs better than a comparable nonselective measure based on cost distribution, clinician-dependent variance, association with cataract surgery-related clinical themes, and quality alignment (higher costs in episodes with complications). Cost measure maintenance and refinement will be important to maintain clinical validity and reliability. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.http://www.sciencedirect.com/science/article/pii/S2666914523000477Cataract surgeryEpisode-based cost measureMACRAMedicareMerit-Based Incentive Payment System |
| spellingShingle | Suzann Pershing, MD, MS Alexander T. Sandhu, MD, MS Aimée-Sandrine Uwilingiyimana, MA David B. Glasser, MD Andrew S. Morgenstern, OD Rose Do, MD Nirmal Choradia, MD Eugene Lin, MD, MS Jasmine Leoung, MPH Miten Shah, MS Ashley Liu, BA, BS Jongwon Lee, MS Amanda Fairchild, MPH Joyce Lam, MPP Thomas E. MaCurdy, PhD Sriniketh Nagavarapu, PhD Jay Bhattacharya, MD, PhD Cataract Surgery in the Medicare Merit-Based Incentive Payment System Ophthalmology Science Cataract surgery Episode-based cost measure MACRA Medicare Merit-Based Incentive Payment System |
| title | Cataract Surgery in the Medicare Merit-Based Incentive Payment System |
| title_full | Cataract Surgery in the Medicare Merit-Based Incentive Payment System |
| title_fullStr | Cataract Surgery in the Medicare Merit-Based Incentive Payment System |
| title_full_unstemmed | Cataract Surgery in the Medicare Merit-Based Incentive Payment System |
| title_short | Cataract Surgery in the Medicare Merit-Based Incentive Payment System |
| title_sort | cataract surgery in the medicare merit based incentive payment system |
| topic | Cataract surgery Episode-based cost measure MACRA Medicare Merit-Based Incentive Payment System |
| url | http://www.sciencedirect.com/science/article/pii/S2666914523000477 |
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