Primary Care's Historic Role in Vaccination and Potential Role in COVID-19 Immunization Programs.

PURPOSE: Coronavirus disease 2019 (COVID-19) pandemic recovery will require a broad and coordinated effort for infection testing, immunity determination, and vaccination. With the advent of several COVID-19 vaccines, the dissemination and delivery of COVID-19 immunization across the nation is of concern. Previous immunization delivery patterns may reveal important components of a comprehensive and sustainable effort to immunize everyone in the nation. METHODS: The delivery of vaccinations were enumerated by provider type using 2017 Medicare Part B Fee-For-Service data and the 2013-2017 Medical Expenditure Panel Survey. The delivery of these services was examined at the service, physician, and visit level. RESULTS: In 2017 Medicare Part B Fee-For-Service, primary care physicians provided the largest share of services for vaccinations (46%), followed closely by mass immunizers (45%), then nurse practitioners/physician assistants (NP/PAs) (5%). The Medical Expenditure Panel Survey showed that primary care physicians provided most clinical visits for vaccination (54% of all visits). CONCLUSIONS: Primary care physicians have played a crucial role in delivery of vaccinations to the US population, including the elderly, between 2012-2017. These findings indicate primary care practices may be a crucial element of vaccine counseling and delivery in the upcoming COVID-19 recovery and immunization efforts in the United States.

COVID-19 and cataract surgery backlog in Medicare beneficiaries.

PURPOSE: To forecast the volume of cataract surgery in Medicare beneficiaries in the United States in 2020 and to estimate the surgical backlog that may be created due to COVID-19. SETTING: Medicare Beneficiaries, United States. DESIGN: Epidemiologic modeling. METHODS: Baseline trends in cataract surgery among Medicare beneficiaries were assessed by querying the Medicare Part B Provider Utilization National Summary data. It was assumed that once the surgical deferment is over, there will be a ramp-up period; this was modeled using a stochastic Monte Carlo simulation. Total surgical backlog 2 years postsuspension was estimated. Sensitivity analyses were used to test model assumptions. RESULTS: Assuming cataract surgeries were to resume in May 2020, it would take 4 months under an optimistic scenario to revert to 90% of the expected pre-COVID forecasted volume. At 2-year postsuspension, the resulting backlog would be between 1.1 and 1.6 million cases. Sensitivity analyses revealed that a substantial surgical backlog would remain despite potentially lower surgical demand in the future. CONCLUSIONS: Suspension of elective cataract surgical care during the COVID-19 surge might have a lasting impact on ophthalmology and will likely result in a cataract surgical patient backlog. These data may aid physicians, payers, and policymakers in planning for postpandemic recovery.