Impact of the COVID-19 Pandemic on Medicare Reimbursement and Glaucoma Procedure Utilization: APayment-VolumeElasticity and Trends Analysis.

Purpose: To examine how the coronavirus disease 2019 (COVID-19) pandemic impacted the relationship between Medicare reimbursement and glaucoma procedure service volume in the United States.

Design: A retrospective, longitudinal database study.

Participants: A complete dataset of all glaucoma procedures performed on Medicare Part B beneficiaries from 2019 to 2022.

Methods: Linear mixed-effects model using Medicare Part B data, controlling for year, charges, denials, reimbursement-to-charge ratio (RCR), service setting, Current Procedural Terminology code, state, Medicare population, number of ophthalmologists, and median income. The RCR was calculated as the ratio of weighted mean reimbursement to weighted mean charge, representing the proportion of reimbursed charges. Weighted averages for denials, charges, and reimbursements (adjusted for inflation) were also calculated.

Main outcome measures: Payment-volume elasticities, defined as the percent change in procedure volume per 1% change in Medicare payment, for traditional glaucoma surgeries (tubes and shunts), minimally invasive glaucoma surgeries (MIGSs), and laser procedures. Additional measures included weighted averages of charges, reimbursements, denials, and RCR across procedure categories and service settings.

Results: Traditional surgeries showed a 2.3% decrease in volume per 1% payment increase (95% confidence interval [CI]: -2.9% to -1.7%; P < 0.001; Rc² = 0.89) and a 10.2% decline in volume. Mean reimbursement for traditional surgeries decreased by 5%, with a 7.7% drop in RCR. Laser procedures exhibited a 6.7% volume decrease per 1% payment increase (95% CI: -7.1% to -6.2%; P < 0.001; Rc² = 0.97) and a 16% total decline, with no change in RCR. Minimally invasive glaucoma surgeries declined by 16.2% overall but demonstrated an 8.3% volume increase per 1% payment rise (95% CI: 7.9%-8.7%; P < 0.001; Rc² = 0.90), with a 64% improvement in RCR. Overall, glaucoma procedure volumes fell by 15.6%, mean reimbursement decreased by 7.3%, and denied claims increased by 46.7%. Ambulatory surgical centers (ASCs) experienced a 15.2% volume decline but an 11.5% increase in reimbursement, supported by a 42.9% rise in RCR.

Conclusions: Glaucoma procedure volumes declined between 2019 and 2022, particularly for traditional surgeries and MIGS. Traditional and laser procedures had negative payment-volume elasticities, whereas MIGS showed positive elasticity. These findings suggest factors beyond reimbursement rates, like shifts to less invasive treatments and COVID-19 disruptions, significantly influenced clinical decision-making.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.