Patient and Physician Perceptions of Medicare Reimbursement Policy for Blepharoplasty and Blepharoptosis Surgery

Published:February 18, 2014DOI:https://doi.org/10.1016/j.ophtha.2014.01.005

      Objective

      To describe patient preferences regarding payment for blepharoplasty and blepharoptosis repair and physician practices before and after the 2009 change in reimbursement for these 2 procedures by the Centers for Medicare and Medicaid Services (CMS).

      Design

      Cross-sectional study.

      Participants

      Fifty patients presenting for functional blepharoplasty and blepharoptosis repair at an academic oculoplastic practice and 198 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery.

      Methods

      A 5-question paper survey was administered to patients, and a 5-question web-based survey was distributed to 510 unique physician e-mail addresses obtained from the American Society of Ophthalmic Plastic and Reconstructive Surgery mailing list server in 2010.

      Main Outcome Measures

      The surveys elicited patient knowledge and attitudes regarding the reimbursement policy of the CMS and physician knowledge and behaviors before and after the reimbursement policy change.

      Results

      Ninety-one percent of patients would be opposed to having to pay out of pocket for blepharoplasty or having to wait at least 3 months after ptosis repair to have a blepharoplasty. When asked to choose between these options, 62% of the patients would rather have the 2 surgeries performed separately than pay out-of-pocket. Before the reimbursement policy change by the CMS, 77% of oculoplastic surgeons performed blepharoplasty and blepharoptosis repair in the same sitting, whereas 37% did so after the policy change ( P < 0.001). Compared with before the policy change by the CMS, more surgeons performed the 2 procedures at least 3 months apart (4% before vs. 29% after, P < 0.001) and more often billed patients for a cosmetic blepharoplasty (5% before vs. 12% after, P = 0.009).

      Conclusions

      Our study suggests that oculoplastic surgeons have made a change in the delivery of ptosis and blepharoplasty surgical services after the reimbursement policy change for these procedures by the CMS in 2009. This change, in which patients undergo separate surgical visits for ptosis repair and blepharoplasty, is not desirable to most patients.

      Abbreviations and Acronyms:

      CMS ( Centers for Medicare and Medicaid Services), NCCI ( National Correct Coding Initiative)
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      References

      1. National Correct Coding Initiative Coding Policy Manual for Medicare Services. Version 16.3. American Medical Association, Chicago, IL2009 (VIII–10)
      2. Centers for Medicare and Medicaid Services. Local coverage determination (LCD): blepharoplasty, blepharoptosis and brow lift (L29973). Available at: http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=29973&ContrId=50&ver=24&ContrVer=1&CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=Minnesota&CptHcpcsCode=15823&bc=gAAAABAAAAAAAA%3d%3d&. Accessed January 2, 2014.

        • Cutler D.M.
        • Ghosh K.
        The potential for cost savings through bundled episode payments.
        N Engl J Med. 2012; 366: 1075-1077
        • Weeks W.B.
        • Rauh S.S.
        • Wadsworth E.B.
        • Weinstein J.N.
        The unintended consequences of bundled payments.
        Ann Intern Med. 2013; 158: 62-64
        • Shen J.
        • Andersen R.
        • Brook R.
        • et al.
        The effects of payment method on clinical decision-making: physician responses to clinical scenarios.
        Med Care. 2004; 42: 297-302
        • Hemani M.L.
        • Makarov D.V.
        • Huang W.C.
        • Taneja S.S.
        The effect of changes in Medicare reimbursement on the practice of office and hospital-based endoscopic surgery for bladder cancer.
        Cancer. 2010; 116: 1264-1271
        • DeWitt E.M.
        • Glick H.A.
        • Albert D.A.
        • et al.
        Medicare coverage of tumor necrosis factor alpha inhibitors as an influence on physicians' prescribing behavior.
        Arch Intern Med. 2006; 166: 57-63
        • Weight C.J.
        • Klein E.A.
        • Jones J.S.
        Androgen deprivation falls as orchiectomy rates rise after changes in reimbursement in the U.S. Medicare population.
        Cancer. 2008; 112: 2195-2201
        • Gosden T.
        • Forland F.
        • Kristiansen I.S.
        • et al.
        Capitation, salary, fee-for-service and mixed systems of payment: effects on the behavior of primary care physicians.
        Cochrane Database Syst Rev. 2000; (3):CD002215
        • Shahinian V.B.
        • Kuo Y.F.
        • Gilbert S.M.
        Reimbursement policy and androgen-deprivation therapy for prostate cancer.
        N Engl J Med. 2010; 363: 1822-1832
        • Federman A.D.
        • Woodward M.
        • Keyhani S.
        Physicians' opinions about reforming reimbursement: results of a national survey.
        Arch Intern Med. 2010; 170: 1735-1742

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