National data show a major shift in eye surgeries from hospitals to less-expensive ambulatory surgery centers where care may be delivered faster and closer to home for some patients.
The proportion of cataract surgeries performed at surgery centers increased steadily, reaching 73% in 2014, compared to 43.6% in 2001, according to a study in JAMA Ophthalmology.
Researchers from the University of Michigan Kellogg Eye Center examined claims data for 369,320 enrollees age 40 and older in a nationwide managed care network who had cataract surgery.
"The increase in utilization occurred in many U.S. communities such that in some places nearly every cataract surgery took place in an ambulatory care center," said senior author Joshua Stein, MD, associate professor of ophthalmology and eye policy researcher at the U-M Institute of Healthcare Policy and Innovation.
The reasons for the increasing popularity of ambulatory surgery centers include convenience, lower out-of-pocket costs for patients, and decreased cost-per-case for insurers. However, hospitals are better prepared than surgery centers if medical complications happen.
One analysis estimated that cataract surgeries performed at ambulatory surgery centers rather than hospitals saved Medicare $829 million in 2011.
Consumers save from the shift to surgery centers where average cataract co-pay in 2014 was $190 compared to $350 at a hospital outpatient department, authors write.
Patients were more likely to undergo cataract surgery at an ambulatory surgery center if they were younger age, had higher income, and lived in states without certificate-of-need laws. CON laws regulate the number of ambulatory care centers permitted to operate.
More affluent people were more likely to live in communities with more ambulatory care centers. This may have the indirect impact of limiting access to cataract surgery for less affluent patients.
The shift is happening beyond cataract surgery and includes cornea, glaucoma, retina and strabismus surgery.
The rate of increase in ambulatory surgery center use for cataract surgery of 2.34% a year was similar to the rate of increase for strabismus surgery and retina surgery.
The rate of increase for glaucoma surgery was faster than cataract surgery. The rate of increase for cornea surgery was slower than cataract surgery.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.