Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Corcoran Consulting Group, San Bernardino, California.
Ophthalmol Glaucoma. 2021 Sep-Oct;4(5):463-471. doi: 10.1016/j.ogla.2021.01.004. Epub 2021 Jan 30.
To evaluate trends in glaucoma procedures in the United States Medicare population and to evaluate which physicians are performing newer procedures.
Analysis of publicly available claims and payment data.
Surgeons and beneficiaries enrolled in United States Medicare between 1994 and 2017.
Data regarding payments to physicians by the Centers for Medicare and Medicaid Services (CMS) were downloaded for the years 2012 through 2017. Data regarding claims to CMS by physicians were requested and processed between 1994 and 2017. Procedure counts from both data sets then were normalized for changes in the Medicare population, with 1995 as the baseline. The normalized volumes of procedures over time were visualized, as were geographic distributions of surgeons and their volume of procedures.
Trends in procedure counts over time, geographic distribution of surgeons, and their volume of procedures.
The number of trabeculectomies continues to decline and now is similar to the number of tubes. Use of the relatively new trabecular bypass shunts has increased rapidly. Surgeons performing these procedures are less likely to be performing traditional glaucoma surgeries as well. The number of laser-based cyclodestruction procedures increased after introduction of the endoscopic technique and again with the introduction of so-called micropulse procedures. The procedure counts obtained with physician payment data consistently are lower than those from claims data given the limitations of the payment data.
Glaucoma practice patterns change each time a new device or procedure is introduced. Collectively, the use of new microinvasive glaucoma surgery procedures has increased rapidly such that they now account for a significant majority of glaucoma surgeries. Given the almost complete lack of comparative data to inform surgeon choices regarding these procedures, it will be important that randomized studies are carried out to fill this gap.
评估美国医疗保险人群中青光眼手术的趋势，并评估哪些医生正在进行新的手术。
对公开的索赔和支付数据进行分析。
1994 年至 2017 年间在美国医疗保险中登记的外科医生和受益人。
下载了医疗保险和医疗补助服务中心（CMS）向医生支付的款项数据，用于 2012 年至 2017 年。要求并处理了医生向 CMS 提出的索赔数据，从 1994 年至 2017 年。然后，从两个数据集计算手术次数的标准化值，将 1995 年作为基线。随着时间的推移，对手术次数的标准化值进行可视化，同时还可视化了外科医生的地理分布及其手术次数。
随时间推移的手术次数趋势、外科医生的地理分布及其手术次数。
小梁切除术的数量继续下降，现在与管的数量相似。相对较新的小梁旁路分流器的使用迅速增加。进行这些手术的外科医生进行传统青光眼手术的可能性也较小。在引入内窥镜技术和所谓的微脉冲手术后，基于激光的环破坏术的手术次数再次增加。由于支付数据的局限性，从医生支付数据中获得的手术次数始终低于从索赔数据中获得的手术次数。
每次引入新设备或手术时，青光眼的治疗模式都会发生变化。总的来说，新的微创青光眼手术的使用迅速增加，以至于现在它们占青光眼手术的很大一部分。鉴于几乎没有比较数据可以为这些手术的外科医生选择提供信息，开展随机研究以填补这一空白将非常重要。
