Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Dana Center for Preventive Ophthalmology, Baltimore, Maryland.
Ophthalmology. 2013 Nov;120(11):2249-57. doi: 10.1016/j.ophtha.2013.04.027. Epub 2013 Jun 12.
To estimate payments for glaucoma care among Medicare beneficiaries from 2002 to 2009.
Database study.
Data from a 5% random sample of Medicare billing information from 2002 to 2009.
Medicare beneficiaries, aged 65 years or older, with both Parts A and B fee-for-service (FFS) enrollment comprised the annual denominator. For each year, we included those with a defined glaucoma diagnostic code linked to a glaucoma visit, diagnostic test, or laser/surgical procedure. Open-angle, angle-closure, and other glaucoma were categorized separately. Claims were classified into glaucoma care, other eye care, and other medical care.
Cost of glaucoma care in the Medicare Fee-for-Service Population.
In 2009, total glaucoma payments by Medicare were $37.4 million for this subset, for an overall estimated cost of $748 million, or 0.4% of an estimated cost of $192 billion for all Medicare FFS payments. Office visits comprised approximately one half, diagnostic testing was approximately one-third, and surgical and laser procedures were approximately 10% of glaucoma-related costs. Coded open-angle glaucoma (OAG) and OAG suspects accounted for 87.5% of glaucoma costs, whereas cost per person was highest in "other glaucoma." In 2009, <3% of patients with OAG underwent incisional surgery and approximately 5% had laser trabeculoplasty. Laser iridotomy was the highest cost category among patients with angle-closure glaucoma, whereas office visits was the highest cost category among the "other glaucoma" group. The total cost of nonglaucoma eye care for patients with glaucoma was 67% higher than their glaucoma care costs; these were chiefly costs for cataract surgery and treatment of retinal diseases. From 2002 to 2009, FFS glaucoma care costs calculated in 2009 dollars were stable and cost per person per year in 2009 dollars decreased from $242 to $228 (P = 0.01 by test for linear trend).
Annual glaucoma care costs per person decreased in constant dollars from 2002 to 2009. Cataract and retinal eye care for patients with glaucoma substantially exceeded the cost of their glaucoma care each year. Visit payments represented the largest category of costs.
估算 2002 年至 2009 年期间医疗保险受益人的青光眼护理费用。
数据库研究。
来自 2002 年至 2009 年的医疗保险计费信息的 5%随机样本数据。
年龄在 65 岁或以上，同时参加医疗保险 A 部分和 B 部分（FFS）的受益人为每年的分母。对于每一年，我们纳入了那些有明确的青光眼诊断代码与青光眼就诊、诊断测试或激光/手术程序相关联的患者。开角型、闭角型和其他青光眼分别归类。索赔分为青光眼护理、其他眼部护理和其他医疗护理。
医疗保险 FFS 人群中青光眼护理的费用。
在 2009 年，医疗保险为此子集中的青光眼支付了 3740 万美元，总估计费用为 7.48 亿美元，占医疗保险 FFS 所有支付费用的 1920 亿美元的 0.4%。就诊占了约一半，诊断测试占了约三分之一，手术和激光程序占了约 10%的青光眼相关费用。编码的开角型青光眼（OAG）和 OAG 疑似患者占青光眼费用的 87.5%，而“其他青光眼”的人均成本最高。在 2009 年，<3%的 OAG 患者接受了切开手术，约 5%的患者接受了激光小梁成形术。在闭角型青光眼患者中，激光虹膜切开术是成本最高的类别，而在“其他青光眼”组中，就诊是成本最高的类别。患有青光眼的患者的非青光眼眼部护理总成本比他们的青光眼护理成本高 67%；这些主要是白内障手术和视网膜疾病治疗的费用。从 2002 年到 2009 年，按 2009 年美元计算的 FFS 青光眼护理成本保持稳定，2009 年按美元计算的人均成本从 242 美元降至 228 美元（线性趋势检验 P = 0.01）。
从 2002 年到 2009 年，每人每年的青光眼护理成本以不变美元计算有所下降。每年患有青光眼的患者的白内障和视网膜眼部护理费用大大超过了他们的青光眼护理费用。就诊支付代表了最大的费用类别。
