Bilateral cataract surgery practiced in 'revenue neutral' arenas

April 17 - Washington, DC - Simultaneous bilateral cataract surgery offers increased efficiency over unilateral cataract surgery by as much as 15%.

However, practitioners are slow to adopt this procedure because of low reimbursements, explained Steve A. Arshinoff, MD, a practitioner based in Toronto, during the refractive/cataract socioeconomic symposium held at the American Society of Cataract and Refractive Surgery annual meeting.

In Canada, reimbursements vary by province, with British Columbia and Alberta in the lower range and the eastern provinces in the higher range.

"So no one does simultaneous bilateral cataract surgery in British Columbia and Alberta, but in the eastern provinces you do almost as well as if you did unilateral surgery and you can make up for it with increased efficiency," Dr. Arshinoff explained.

There is an added problem in Canada. Anesthesiologists, which are required in most operating rooms in Canada, also receive low reimbursements.

"In fact, in the eastern provinces where the surgeons do well, the anesthesiologists do the worst," he reported.

Therefore everywhere with poor reimbursement, physicians resist doing simultaneous bilateral cataract surgery, Dr. Arshinoff pointed out.

In Australia, Japan, and Israel, the reimbursement is low or non-existent for the second eye, so physicians do not adopt the procedure. In the United Kingdom, physicians do well, receiving 90% of what they would receive doing unilateral cataract surgery. In the United States under Medicare, physicians lose a lot.

"Bilateral surgery is most common in the United Kingdom where reimbursement is revenue neutral," he said.