Department of Ophthalmology, Corewell Health William Beaumont University Hospital, Royal Oak, MI, United States of America.
Loma Linda Eye Institute, Loma Linda, CA, United States of America.
PLoS One. 2024 Sep 9;19(9):e0310140. doi: 10.1371/journal.pone.0310140. eCollection 2024.
To determine the rate of Medicare opt-out among optometrists and ophthalmologists and to contrast the differences in the characteristics and geographic distribution of these populations.
A retrospective cross-sectional study.
Using a publicly available Centers for Medicare & Medicaid Services (CMS) data set, we collated data for ophthalmologists and optometrists who opted out in each year between 2005 and 2023. We calculated the rate of opt-out annually in each year window and cumulatively from 2005 to 2023. Comparative analysis was used to identify clinician characteristics associated with opt-out.
Both annual and cumulative rate of ophthalmologist and optometrist opt-out from Medicare.
The estimated prevalence of Medicare opt-outs was 0.52% (77/14,807) for ophthalmologists and 0.38% (154/40,526) for optometrists. Ophthalmologists opting out were predominantly male (67.5%), had a longer practice duration (average 31.8 years), and were more often located in urban areas (83.1%), compared to optometrists (53.2% male, average 19.6 years in practice, 59.1% in urban areas, p = 0.04, p<0.001, p<0.001 respectively). Approximately 83% of ophthalmologists were either anterior segment or oculoplastics specialties, while the majority (52.1%) of optometrists were in optometry-only practices; >75% of identified clinicians were in private practice. Geographical distribution across the US showed variable opt-out rates, with the top 3 states including Oklahoma (3.4%), Arizona (2.1%), and Kansas (1.6%) for ophthalmology and Idaho (4.3%), Montana (3.1%), and Wyoming (1.4%) for optometry.
Few ophthalmologists and optometrists opt-out of Medicare but this trend has significantly increased since 2012. Of those who disenrolled from Medicare, 83% of ophthalmologists were in urbanized areas while 41% of optometrists were in non-urbanized areas. Because reasons for Medicare opt-out cannot be solely determined by administrative data, further investigation is warranted given the potential impact on healthcare accessibility.
确定眼科医生和验光师退出医疗保险的比例，并对比这两个群体的特征和地理分布差异。
回顾性横断面研究。
利用公开的医疗保险和医疗补助服务中心（CMS）数据集，我们整理了 2005 年至 2023 年期间每年选择退出的眼科医生和验光师的数据。我们计算了每年每个年份窗口和 2005 年至 2023 年期间的累计退出率。采用比较分析来确定与退出相关的临床医生特征。
眼科医生和验光师从医疗保险中退出的年度和累计退出率。
眼科医生退出医疗保险的估计患病率为 0.52%（77/14807），验光师为 0.38%（154/40526）。与验光师相比，选择退出的眼科医生主要为男性（67.5%），执业时间更长（平均 31.8 年），且更多位于城市地区（83.1%）（53.2%为男性，平均执业年限为 19.6 年，59.1%在城市地区，p=0.04，p<0.001，p<0.001）。约 83%的眼科医生为眼前段或眼整形专科医生，而大多数（52.1%）的验光师在仅验光的实践中；>75%的确定的临床医生在私人执业中。美国各地的地理分布显示出不同的退出率，前 3 个州包括俄克拉荷马州（3.4%）、亚利桑那州（2.1%）和堪萨斯州（1.6%），眼科医生；爱达荷州（4.3%）、蒙大拿州（3.1%）和怀俄明州（1.4%），验光师。
只有少数眼科医生和验光师退出医疗保险，但自 2012 年以来，这一趋势显著增加。退出医疗保险的医生中，83%的眼科医生在城市化地区，而 41%的验光师在非城市化地区。由于不能仅通过行政数据确定退出医疗保险的原因，鉴于对医疗保健可及性的潜在影响，需要进一步调查。
