Preoperative consultations before cataract surgery became more common for Medicare patients despite no clear guidelines about when to require such a service, hinting at unnecessary use of health care resources, according to a study published by JAMA Internal Medicine.
Preoperative medical consultation is a common health care service that can be billed separately to Medicare. There is little information about how often preoperative consultation is performed among the large numbers of patients in the United States who undergo elective, low-risk surgical procedures that may not require routine consultation, and how the referral for such consultation varies by patient, facility and geographic region, according to the study background.
Stephan R. Thilen, M.D., M.S., of the University of Washington, Seattle, and colleagues measured consultations performed by family practitioners, general internists, pulmonologists, endocrinologists, nurse practitioners or anesthesiologists as early as 42 days before cataract surgery. Researchers analyzed a 5 percent sample of Medicare part B claims, which included 556,637 patients 66 years or older who had cataract surgery from 1995 to 2006.
The study findings indicate preoperative consultations became more common, increasing from 11.3 percent in 1998 to 18.4 percent in 2006. Older patients (age 75 to 84 years) were more likely to have a consultation than patients between age 66 to 74 years, while patients who were black or lived in a rural area were less likely to receive a consultation. Those patients who had their cataract surgery in an inpatient or outpatient hospital had higher odds of having a consultation than those whose surgery was performed in an office. Patients who had an anesthesiologist involved with their care (either personally administering it or medically directing or supervising certified registered nurse anesthesists) also had higher odds of having a preoperative consultation. Living in the northeast also meant higher odds that a patient would have a consultation compared with patients living in the South or West.
"This large retrospective study suggests that there was substantial use of preoperative medical consultation for cataract surgery and that referrals for consultation had increased during the study period. With the exception of age, referral for preoperative consultation seems driven primarily by nonmedical factors including practice setting, type of anesthesia provider and geographical region," the authors conclude. "These data highlight an area of opportunity for interventions aimed at reducing unwanted practice variability in a process that has the potential to consume vast amounts of health care resources."
In a related commentary, Lee A. Fleisher, M.D., of the University of Pennsylvania, Philadelphia, writes: "A major theme within the Choosing Wisely campaign has been the elimination of routine preoperative evaluation in low-risk patients. … In this issue of JAMA Internal Medicine, Thilen and colleagues demonstrate not only that this is not occurring but that the incidence of preoperative consultations is actually increasing in the Medicare population for patients undergoing cataract surgery."
"The results of this study suggest that a great deal of low-value care is occurring among patients who undergo cataract surgery," Fleisher continues.
"So how do we ensure that provision of low-value or no-value care is reduced or eliminated? Payment reform in which either the entire surgical episode is bundled or the patient is enrolled in an accountable care organization may itself lead to more appropriate use of consultation and testing. It will be important for physicians, armed with this information about current practice patterns, to take the lead in choosing wisely with respect to which patients require a consultation and test before external forces do it for us," Fleisher concludes.
Explore further: Pre-op depression linked to narcotic use before spinal Sx
More information: JAMA Intern Med. Published online December 23, 2013. DOI: 10.1001/jamainternmed.2013.13426
JAMA Intern Med. Published online December 23, 2013. DOI: 10.1001/jamainternmed.2013.12298
Medical Xpress on facebook
Related Stories
Pre-op depression linked to narcotic use before spinal Sx
Dec 19, 2013
(HealthDay)—For patients undergoing spinal surgery for a structural lesion, preoperative depression and anxiety are associated with increased preoperative narcotic use, according to a study published in ...
Antibiotics before heart surgery protect against infection
5 hours ago
A new study found preoperative antibiotic therapy administered within two hours of cardiac surgery decreased the risk of developing surgical site infections (SSIs) significantly. The study was published in the January issue ...
Pre-op physiatry consultation reduces spinal surgery rates
Feb 05, 2013
(HealthDay)—Requiring patients interested in spinal surgery to first see a rehabilitation physician reduces the number of spinal surgeries, reduces costs, and leaves patients largely satisfied, according ...
Early emergency department palliative care consultations resulted in significantly shorter hospital stays
Dec 11, 2013
New York University College of Nursing researcher and Assistant Professor Abraham A. Brody, RN, PhD, GNP-BC and colleagues reporting in Journal of Palliative Medicine found that initiating a palliative care c ...
History of falls linked to post-surgery complications in seniors
Oct 10, 2013
(HealthDay)—Seniors who've had one or more falls in the six months prior to surgery are at increased risk for poorer outcomes after their operation, according to a new study.
Recommended for you
Preop testing for low-risk cataract surgery patients: Choosing wisely or low-value care?
3 seconds ago
The elimination of extensive routine preoperative tests and consultations represents an area of potentially large health care savings across many disciplines, particularly for low-risk patients being evaluated for cataract ...
Key step in developing a drug that tricks the brain into being less hungry
Dec 20, 2013
Lap-band surgery is maintaining support in Australia's health system with calls for the procedure to be made available to overweight teens and those who suffer diabetes.
Nearly 8 percent of hip implants not backed by safety evidence
Dec 19, 2013
Almost 8 percent of all implants used in hip replacement surgery have no readily available evidence relating to their safety or effectiveness, finds a study published in BMJ today.
Pre-op depression linked to narcotic use before spinal Sx
Dec 19, 2013
(HealthDay)—For patients undergoing spinal surgery for a structural lesion, preoperative depression and anxiety are associated with increased preoperative narcotic use, according to a study published in ...
Old-age specialists may boost recovery among injured seniors
Dec 19, 2013
(HealthDay)—Seniors who suffer an injury are more likely to regain their independence if they consult a geriatric specialist during their hospital stay, researchers report.
With sinus study, researchers find that harmless members of microbiome spark immune reaction
Dec 19, 2013
Saint Louis University researchers have analyzed the microbiomes of people with chronic rhinosinusitis and healthy volunteers and found evidence that some chronic sinus issues may be the result of inflammation triggered by ...
User comments
© Medical Xpress 2011-2013, Science X network
Preoperative consultations before cataract surgery became more common for Medicare patients despite no clear guidelines about when to require such a service, hinting at unnecessary use of health care resources, according to a study published by JAMA Internal Medicine.
Preoperative medical consultation is a common health care service that can be billed separately to Medicare. There is little information about how often preoperative consultation is performed among the large numbers of patients in the United States who undergo elective, low-risk surgical procedures that may not require routine consultation, and how the referral for such consultation varies by patient, facility and geographic region, according to the study background.
Stephan R. Thilen, M.D., M.S., of the University of Washington, Seattle, and colleagues measured consultations performed by family practitioners, general internists, pulmonologists, endocrinologists, nurse practitioners or anesthesiologists as early as 42 days before cataract surgery. Researchers analyzed a 5 percent sample of Medicare part B claims, which included 556,637 patients 66 years or older who had cataract surgery from 1995 to 2006.
The study findings indicate preoperative consultations became more common, increasing from 11.3 percent in 1998 to 18.4 percent in 2006. Older patients (age 75 to 84 years) were more likely to have a consultation than patients between age 66 to 74 years, while patients who were black or lived in a rural area were less likely to receive a consultation. Those patients who had their cataract surgery in an inpatient or outpatient hospital had higher odds of having a consultation than those whose surgery was performed in an office. Patients who had an anesthesiologist involved with their care (either personally administering it or medically directing or supervising certified registered nurse anesthesists) also had higher odds of having a preoperative consultation. Living in the northeast also meant higher odds that a patient would have a consultation compared with patients living in the South or West.
"This large retrospective study suggests that there was substantial use of preoperative medical consultation for cataract surgery and that referrals for consultation had increased during the study period. With the exception of age, referral for preoperative consultation seems driven primarily by nonmedical factors including practice setting, type of anesthesia provider and geographical region," the authors conclude. "These data highlight an area of opportunity for interventions aimed at reducing unwanted practice variability in a process that has the potential to consume vast amounts of health care resources."
In a related commentary, Lee A. Fleisher, M.D., of the University of Pennsylvania, Philadelphia, writes: "A major theme within the Choosing Wisely campaign has been the elimination of routine preoperative evaluation in low-risk patients. … In this issue of JAMA Internal Medicine, Thilen and colleagues demonstrate not only that this is not occurring but that the incidence of preoperative consultations is actually increasing in the Medicare population for patients undergoing cataract surgery."
"The results of this study suggest that a great deal of low-value care is occurring among patients who undergo cataract surgery," Fleisher continues.
"So how do we ensure that provision of low-value or no-value care is reduced or eliminated? Payment reform in which either the entire surgical episode is bundled or the patient is enrolled in an accountable care organization may itself lead to more appropriate use of consultation and testing. It will be important for physicians, armed with this information about current practice patterns, to take the lead in choosing wisely with respect to which patients require a consultation and test before external forces do it for us," Fleisher concludes.
Explore further: Pre-op depression linked to narcotic use before spinal Sx
More information: JAMA Intern Med. Published online December 23, 2013. DOI: 10.1001/jamainternmed.2013.13426
JAMA Intern Med. Published online December 23, 2013. DOI: 10.1001/jamainternmed.2013.12298
Medical Xpress on facebook
Related Stories
Pre-op depression linked to narcotic use before spinal Sx
Dec 19, 2013
(HealthDay)—For patients undergoing spinal surgery for a structural lesion, preoperative depression and anxiety are associated with increased preoperative narcotic use, according to a study published in ...
Antibiotics before heart surgery protect against infection
5 hours ago
A new study found preoperative antibiotic therapy administered within two hours of cardiac surgery decreased the risk of developing surgical site infections (SSIs) significantly. The study was published in the January issue ...
Pre-op physiatry consultation reduces spinal surgery rates
Feb 05, 2013
(HealthDay)—Requiring patients interested in spinal surgery to first see a rehabilitation physician reduces the number of spinal surgeries, reduces costs, and leaves patients largely satisfied, according ...
Early emergency department palliative care consultations resulted in significantly shorter hospital stays
Dec 11, 2013
New York University College of Nursing researcher and Assistant Professor Abraham A. Brody, RN, PhD, GNP-BC and colleagues reporting in Journal of Palliative Medicine found that initiating a palliative care c ...
History of falls linked to post-surgery complications in seniors
Oct 10, 2013
(HealthDay)—Seniors who've had one or more falls in the six months prior to surgery are at increased risk for poorer outcomes after their operation, according to a new study.
Recommended for you
Preop testing for low-risk cataract surgery patients: Choosing wisely or low-value care?
3 seconds ago
The elimination of extensive routine preoperative tests and consultations represents an area of potentially large health care savings across many disciplines, particularly for low-risk patients being evaluated for cataract ...
Key step in developing a drug that tricks the brain into being less hungry
Dec 20, 2013
Lap-band surgery is maintaining support in Australia's health system with calls for the procedure to be made available to overweight teens and those who suffer diabetes.
Nearly 8 percent of hip implants not backed by safety evidence
Dec 19, 2013
Almost 8 percent of all implants used in hip replacement surgery have no readily available evidence relating to their safety or effectiveness, finds a study published in BMJ today.
Pre-op depression linked to narcotic use before spinal Sx
Dec 19, 2013
(HealthDay)—For patients undergoing spinal surgery for a structural lesion, preoperative depression and anxiety are associated with increased preoperative narcotic use, according to a study published in ...
Old-age specialists may boost recovery among injured seniors
Dec 19, 2013
(HealthDay)—Seniors who suffer an injury are more likely to regain their independence if they consult a geriatric specialist during their hospital stay, researchers report.
With sinus study, researchers find that harmless members of microbiome spark immune reaction
Dec 19, 2013
Saint Louis University researchers have analyzed the microbiomes of people with chronic rhinosinusitis and healthy volunteers and found evidence that some chronic sinus issues may be the result of inflammation triggered by ...
User comments
© Medical Xpress 2011-2013, Science X network
0 comments:
Post a Comment