An analysis of medicaid reimbursement trends in pediatric ophthalmology in Arizona: 2015 to 2021

ABSTRACT

Introduction: A paucity of data exists regarding reimbursement trends in pediatric ophthalmology, especially regarding the consequences of national policy enacted to minimize the COVID-19 pandemic's effect on access to healthcare. The purpose of this study was to evaluate monetary trends for common pediatric ophthalmology procedures among the Arizona Medicaid population, compared to Medicare data. Method(s) Publicly available Arizona Medicaid and Medicare Physician Fee Schedules from 2015-2021 were utilized. Collected data included reimbursement for common procedural and nonprocedural (examination, imaging) billing codes used in pediatric ophthalmology. Data was adjusted for inflation to 2021 dollars. Result(s) From 2015-2020, the inflation-adjusted average Arizona Medicaid and Medicare reimbursement for all procedures decreased by 9% from 2015-2020 (-2% per year) and 12% (-2% per year), respectively. From 2020-2021, average procedural Medicaid reimbursement increased by 11%, while Medicare decreased by 6%. From 2015 to 2020, average nonprocedural Medicaid and Medicare reimbursement decreased by 16% (-3% per year) and 18% (-4% per year), respectively. Average non-procedural Medicaid reimbursement increased by 8% from 2020-2021, while Medicare decreased by 2%. No significant difference was observed between Arizona and national Medicare trends (P > 0.05). Conclusion/Relevance Arizona Medicaid and Medicare reimbursement steadily decreased from 2015-2020, but Medicaid reimbursement markedly increased from 2020-2021. This reflects a 6.2% increase in federal Medicaid funding to states enacted by Congress in 2020, which will end after the public health emergency. In light of recent decreases in outpatient utilization due to the COVID-19 pandemic, increased awareness of these trends is needed to maintain adequate access to pediatric ophthalmologic care, particularly among Medicaid enrollees. Copyright © 2022