A recent study in the New England Journal of Medicine suggests that clinicians vastly overprepare patients for cataract procedures, driving up costs dramatically.
Researchers conclude that 53 percent of Medicare patients receive at least one pre-operative test before undergoing a cataract procedure, even though that is not the recommended practice these days. The average cataract surgery takes 18 minutes to perform and has a complication rate below 1 percent.
The study examined 440,857 Medicare enrollees prior to undergoing cataract surgery. Expenditures on testing for that cohort 30 days prior to the surgery were 42 percent higher than the average spend on testing for those patients in the previous 11 months. That drove costs up by $4.8 million overall.
Testing, however, varies widely among ophthalmologists. A small group accounts for more than 84 percent of the excess tests performed, the University of California San Francisco (UCSF) reported.
Catherine Chen, M.D., an anesthesiologist at UCSF and the lead author of the study, told Kaiser Health News that such pre-operative testing made sense when patients still underwent general anesthesia to have their cataracts removed. These days, most patients receive little more than a topical anesthesia prior to having their cataracts removed. "It suggests that it's habit or practice patterns," Chen said.
Other factors may also come into play: Some physicians practice defensive medicine in order to avoid lawsuits or even being bad-mouthed by their colleagues. Hospital administrators estimate that one third of healthcare costs are the result of tests and treatments that aren't medically necessary.