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Abstract
PurposeTo quantify differences in the age, gender, race, and clinical complexity of Medicare beneficiaries treated by ophthalmologists and optometrists in each of the United States.DesignCross-sectional study based on publicly accessible Medicare payment and utilization data from 2012 through 2017.MethodsFor each ophthalmic and optometric provider, demographic information of treated Medicare beneficiaries was obtained from the Medicare Provider Utilization and Payment Data from the Centers for Medicare and Medicaid Services (CMS) for the years 2012 through 2017. Clinical complexity was defined using CMS Hierarchical Condition Category (HCC) coding.ResultsFrom 2012 through 2017, ophthalmologists in every state treated statistically significantly older beneficiaries, with the greatest difference (4.99 years in 2014) between provider groups seen in Rhode Island. In most states there was no gender difference among patients treated by the providers but in 46 states ophthalmologists saw a more racially diverse group of beneficiaries. HCC risk score analysis demonstrated that ophthalmologists in all 50 states saw more medically complex beneficiaries and the differences were statistically significant in 47 states throughout all six years.ConclusionsAlthough there are regional variations in the characteristics of patients treated by ophthalmologists and optometrists, ophthalmologists throughout the United States manage older, more racially diverse, and more medically complex Medicare beneficiaries.
Highlights
Aging of the American population, with movement of the large post-world war II “baby boomers” cohort into the Medicare-covered age group, has substantially increased the prevalence of age-related eye diseases and the need for both primary and sub-specialty ophthalmology services [1, 2]
From 2012 through 2017, ophthalmologists in every state treated statistically significantly older beneficiaries, with the greatest difference (4.99 years in 2014) between provider groups seen in Rhode Island
Hierarchical Condition Category (HCC) risk score analysis demonstrated that ophthalmologists in all 50 states saw more medically complex beneficiaries and the differences were statistically significant in 47 states throughout all six years
Summary
Aging of the American population, with movement of the large post-world war II “baby boomers” cohort into the Medicare-covered age group, has substantially increased the prevalence of age-related eye diseases and the need for both primary and sub-specialty ophthalmology services [1, 2]. Advancements in imaging technology, ocular pharmacotherapy, and ophthalmic surgery have broadened the spectrum of treatable disease, further increasing the total amount of eye care delivered [2, 3]. Together, these factors suggest that a shortage of eye care providers may develop during the 20 years. Diagnostic procedures and treatments are performed by both professions, but because of differences in education, training, and licensure, scopes of practice differ between the two specialties both within states and between states [5] This cross-sectional study evaluated the 2012 through 2017 Medicare Provider Utilization and Payment Data released by the Centers for Medicare and Medicaid Services (CMS) (https:// data.cms.gov) Information about the average age of the beneficiaries, the number of male and female beneficiaries, the number of Caucasian beneficiaries, and the average Risk Adjustment and Hierarchical Condition Category (HCC) coding score–used as a measure of clinical complexity—was collected
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