Extra consultations before cataract surgery rise

A study of U.S. Medicare claims finds a jump in extra doctor consultations before cataract surgery, but no clear medical reason for the added costs.

"The preoperative medical consultation is an understudied area. It's an intervention that we spend several billion dollars on each year in this country. We know surprisingly little about the process," Dr. Stephen Thilen told Reuters Health.

"What we're studying here is how often do we bring a third provider in - a service that is in addition to the others and it's separately billed. It adds an expense," said Thilen, an assistant professor of anesthesiology and pain medicine at the University of Washington in Seattle who led the study.

A cataract is a medical condition in which the lens of the eye becomes opaque and causes blurred vision.

Surgery to remove the cataract is generally low-risk, and is the most common elective surgery performed on beneficiaries of Medicare, the U.S. health insurance program for people over 65.

Patients awaiting cataract surgery generally see the ophthalmologist who performs the surgery and the anesthesiologist or anesthetist if one is needed. Both consultations are covered by the flat price Medicare pays those providers for the surgery.

Thilen's team looked at trends in additional preoperative consultations with the patient's family doctor, cardiologist, pulmonologist, endocrinologist or other physician not directly involved in the surgery.

So far, little is known about the value of these extra consultations when patients are involved in lower-risk procedures, such as most cataract surgeries, Thilen said.

"There has been more published on high risk patients. Generally we would expect patients coming for heart surgery, liver transplants, vascular surgery - those high risk procedures - we would expect them to often have preoperative medical consultations because they're high risk patients and they have many issues that need to be addressed," Thilen said.

No national guidelines indicate whether and when cataract surgery patients need an additional preoperative consultation, Thilen and his colleagues write in JAMA Internal Medicine.

So they looked at Medicare billing data for 556,637 patients who had their first cataract surgeries between 1995 and 2006 and found that the proportion of patients getting preoperative medical consultations rose from 11 percent in 1995 to 18 percent in 2006.

When they analyzed claims for the last two years of that period, they found the patients most likely to have the extra consultations tended to be older and also had anesthesiologists involved in their care. The number of consultations was also higher in urban areas and they were about three times more common in the northeastern U.S. compared to the South.

The researchers did not have access to clinical records so they don't know why any of the consultations were ordered or if they added any value to patient care.