Cataract surgery cost-effective

San Francisco-Contrary to claims made in a recent op-ed piece in The Wall Street Journal, cataract surgery “is one of the most cost-effective major surgical procedures available today,” said American Academy of Ophthalmology (AAO) President Richard L. Abbott, MD, in an open letter.

In “Three simple ways Medicare can save money,” published Aug. 11, National Center for Policy Analysis President and Chief Executive Officer John C. Goodman used inaccurate data when describing ways to improve the Medicare program, Dr. Abbott said.

As an example of a flawed Medicare system, Goodman said: “This year, Medicare is paying $111.36 for the [primary-care physician (PCP)] visit. The ophthalmologist, meanwhile, is raking in $836.36 (including the patient co-payment). Medicare is paying 7.5 times more for cataract removal than for a primary care visit. If we measure according to the time spent to earn the fee, Medicare is paying the ophthalmologist 15 times what it pays the PCP.”

The calculation, according to Dr. Abbott, fails to consider that the true time needed to perform cataract surgery is 30 minutes, not the 10 to 15 minutes Goodman cited. Further, according to Dr. Abbott, the calculation does not factor in the 3 months of follow-up exams required after the surgery and the 10% payment bonus paid to PCPs in 2011.

Ophthalmologists effectively receive $221 from Medicare for cataract surgery after accounting for practice expenses, malpractice costs, and $222 for postoperative office visits, Dr. Abbott contended. In contrast, he said, a PCP receives $51 (“pre-bonus”) for an office visit.

“One can debate whether this 4:1 ratio is proper, but it is not the 15:1 ratio that Mr. Goodman dramatically claims,” Dr. Abbott wrote. “Nor do we feel that most patients would consider $221 to be an exorbitant charge for a technically challenging and ever-changing operation with remarkably high success in safely restoring vision and functional ability.”

Just as the services provided by ophthalmologists hold much value, PCPs play a “vital role” in health care, Dr. Abbott wrote. “We will continue to work with them, as we have in the past, to develop physician compensation models that reflect a patient-centered, value-based approach for physician payment.”