IS OPHTHALMOLOGIC TREATMENT DRIVEN BY FINANCIAL INCENTIVES?

One of the "controversies" that allegedly exists in the optometric prescribing of vision therapy and "low power lenses" is that our professional judgment is clouded by financial incentives. That claim, leveled by critics of vision therapy, has never been proven and remains anecdotal. Our principal critics are, of course, ophthalmologists who seem not at all bothered by the paradox of using anecdotal claims to criticize us because we supposedly rely on anecdotal evidence.

I couldn't help smile, therefore, when I read the following this afternoon:

http://www.ophthalmologyweb.com/News.aspx?spid=23&newsid=317326...

Medicare Patients 5.5 Times More Likely To Get Cataract Surgery Than VA Patients, Study Finds

Indiana University School of Medicine

3 / 19 / 2010

INDIANAPOLIS – Patients seen at private facilities reimbursed by Medicare were more than 550 percent more
likely to have routine cataract surgery than those who received their care from
the Department of Veterans Affairs, a strong indication that the frequency of
cataract surgery may be responsive to financial incentives to either or both
the medical facility and the physicians who perform the procedure.

These findings from a large eight-year study are reported in the March 2010 issue of the American Journal
of Medical Quality.

The authors are uncertain of the cause of the disparity in cataract surgery given that the vast majority of
older veterans are enrolled in both Medicare and the VA health system, both
government-funded systems.

“We don’t know yet what exactly accounts for the five and a half fold difference in surgery rates between the
two systems. It may be related to how the two systems are funded by the
government, it could be a difference between physician-driven decisions or it
may be related to a lack of ophthalmologists within the VA system or it could
be more than one of these factors,’ said first author Dustin French, Ph.D.,
Regenstrief Institute investigator and assistant professor of medicine at the
Indiana University School of Medicine. Dr. French is a health economist who
studies health outcomes.

VA physicians and hospitals do not have the same financial incentives to perform cataract surgery as physicians
and medical facilities outside the VA system.

“The results of our study raise important questions about the possible existence of a two-tier, federally
funded health-care system that may not be equivalent in terms of quality of
care,” said Dr. French, who is also a research scientist with the Center of
Excellence on Implementing Evidence Based Practice at the Richard A. Roudebush
VA Medical Center.

The authors note that their findings provide ample reason to further investigate the determinants of cataract
surgery rates. Nationwide, cataract surgery is the most common surgical
procedure performed by ophthalmologists.

In addition to Dr. French, co-authors of “Cataract Surgery Among Veterans 65 Years and Older: Analysis of National
Veterans Health Administration Databases” are Curtis E. Margo, M.D.,
MPH of the University of South Florida’s departments of ophthalmology and
pathology; and Robert R. Campbell, J.D., MPH, Ph.D., of the Department of
Veterans Affairs. The authors received no financial support for the research and
authorship of the study.

The Regenstrief Institute and the IU School of Medicine are located on the Indiana University-Purdue University
Indianapolis campus.