Trends in Vitreoretinal Procedures for Medicare Beneficiaries, 2000 to 2014.

TOPIC: The purpose of this study was to identify changes in use for vitreoretinal procedures by measuring the number of allowed services using data from the US Medicare Part B Fee-for-Service (FFS) beneficiaries and their providers. CLINICAL RELEVANCE: To analyze vitreoretinal procedural trends, which may indicate standard of care and importance of developing methods of treatments. METHODS: Medicare Part B National Summary Data Files for calendar years 2000 to 2014 were used to identify the number of allowed services for vitreoretinal procedures and commonly used pharmacologic agents. Linear regression analysis was performed to identify trends in use. MAIN OUTCOME MEASURES: To analyze vitreoretinal procedural trends, which may indicate standard of care and importance of developing methods of treatments. RESULTS: Vitreoretinal procedures grew 6-fold from 2000 to 2014. Intravitreal injections were the primary driver of growth. A total of 2922 injections were performed in 2000, compared with 2 619 950 injections in 2014 (P < 0.01). Scleral buckling declined from 6502 procedures in 2000 to 1260 procedures in 2014 (P < 0.01), whereas vitrectomy use for retinal detachment increased from 13 814 surgeries in 2008 to 19 288 surgeries in 2014 (P < 0.01). Focal laser treatments declined from 188 351 procedures in 2002 to 83 379 procedures in 2014 (P < 0.01). Panretinal photocoagulation treatments declined from 109 840 procedures in 2004 to 81 005 procedures in 2014 (P < 0.01). CONCLUSIONS: Vitreoretinal practice patterns changed significantly from 2000 to 2014. Intravitreal injections increased by 89 563%. Intravitreal injections accounted for 0.55% of all vitreoretinal procedures in 2000 and increased to 87% in 2014. Scleral buckling sharply declined, and preference for retinal detachment repair shifted further toward vitrectomy with a distribution of 83% vitrectomy, 5% scleral buckling, and 12% pneumatic retinopexy in 2014. Use of laser photocoagulation significantly declined for treatment of macular edema and proliferative retinopathy. Cryotherapy procedures declined across all indications.

Surgical Assistant Use in Vitreoretinal Surgery.

PURPOSE: To evaluate the use of surgical assistants in vitreoretinal surgery. DESIGN: Database study. PARTICIPANTS: Data from US Medicare Part B fee-for-service beneficiaries and their providers. METHODS: Medicare Part B National Summary Data Files for calendar years 2000 through 2014 were used to identify the number of services billed by assistant and primary surgeons for vitreoretinal surgeries. The proportion of procedures involving an assistant was determined for each year. Linear regression analysis was performed to identify trends in use. MAIN OUTCOME MEASURE: Percentage of vitreoretinal procedures using an assistant surgeon. RESULTS: From 2000 through 2014, 12% of eligible vitreoretinal surgeries (216 637/1 808 377) involved a surgical assistant. In 2000, 14% (13 115/94 742) of vitreoretinal surgeries used a surgical assistant compared with 10% in 2014 (13 360/136 945). In this 15-year period, there was a statistically significant decline in the proportion of vitreoretinal procedures using an assistant (P < 0.01). CONCLUSIONS: From 2000 through 2014, surgical assistants were used in 12% of vitreoretinal surgeries. The percentage of cases using an assistant declined from 14% in 2000 to 10% in 2014 (P < 0.01), a 29% decline. This decline may be secondary to technological advances in vitrectomy, which confer greater surgeon independence, and a marked decline in scleral buckling procedures.