Trends over time and regional variations in the rate of laser trabeculoplasty in the medicare population

Henry D Jampel, Sandra Cassard, David S Friedman, Nakul S. Shekhawat, Julia Whiteside-de Vos, Harry A Quigley, Emily W. Gower

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Laser trabeculoplasty (LTP) is routinely used to treat open-angle glaucoma; hence, understanding variations in its use over time and region is important. OBJECTIVE: To determine trends over time and the regional variation in the performance of LTP. DESIGN, SETTING, AND PARTICIPANTS: Database analysis of a 5%random sample of all Medicare beneficiaries 65 years or older with continuous Part B (medical insurance) coverage and no enrollment in a health maintenance organization for each year from 2002 through 2009. INTERVENTIONS: We counted unique claims with a Current Procedural Terminology code of 65855 (LTP) submitted by ophthalmologists, optometrists, ambulatory surgery centers, or outpatient hospitals by region for each year.We examined trends over time and regional variation in LTP rates in 9 large geographic regions. MAIN OUTCOMES AND MEASURES: Rate of LTP per 10 000 Medicare beneficiary person-years and per 10 000 diagnosed open-angle glaucoma (OAG) person-years. RESULTS: The LTP rates per 10 000 Medicare beneficiary person-years were 36.3, 60.1, and 53.5 for 2002, 2006, and 2009, respectively. The 65.6%increase between 2002 and 2006 and the 11.0% decrease between 2006 and 2009 were statistically significant (tests for linear trend, P = .009 and P <.001, respectively). Similarly, the LTP rate among Medicare beneficiaries with OAG increased from 507.9 per 10 000 person-years in 2002 to 824.3 per 10 000 person-years in 2006 (62.3% increase; P = .009) and then decreased to 741 per 10 000 person-years by 2009 (10.1% decrease; P = .004). The rates per 10 000 OAG person-years differed significantly by region, ranging from 314 in the East South-Central region to 607 in the East North-Central region in 2002 (93.2% higher; P <.001). A similar range of variation was observed in subsequent years. CONCLUSIONS AND RELEVANCE: The rate of LTP for Medicare patients with OAG peaked in 2006 and then decreased through 2009. Nearly twice as many LTP procedures per Medicare beneficiary were performed in some regions compared with others throughout the period.

Original languageEnglish (US)
Pages (from-to)685-690
Number of pages6
JournalJAMA Ophthalmology
Volume132
Issue number6
DOIs
StatePublished - 2014

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Trabeculectomy
Medicare
Lasers
Open Angle Glaucoma
Population
Current Procedural Terminology
Insurance Coverage
Health Maintenance Organizations
Ambulatory Surgical Procedures
Outpatients
Databases

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Trends over time and regional variations in the rate of laser trabeculoplasty in the medicare population. / Jampel, Henry D; Cassard, Sandra; Friedman, David S; Shekhawat, Nakul S.; Whiteside-de Vos, Julia; Quigley, Harry A; Gower, Emily W.

In: JAMA Ophthalmology, Vol. 132, No. 6, 2014, p. 685-690.

Research output: Contribution to journalArticle

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abstract = "IMPORTANCE: Laser trabeculoplasty (LTP) is routinely used to treat open-angle glaucoma; hence, understanding variations in its use over time and region is important. OBJECTIVE: To determine trends over time and the regional variation in the performance of LTP. DESIGN, SETTING, AND PARTICIPANTS: Database analysis of a 5{\%}random sample of all Medicare beneficiaries 65 years or older with continuous Part B (medical insurance) coverage and no enrollment in a health maintenance organization for each year from 2002 through 2009. INTERVENTIONS: We counted unique claims with a Current Procedural Terminology code of 65855 (LTP) submitted by ophthalmologists, optometrists, ambulatory surgery centers, or outpatient hospitals by region for each year.We examined trends over time and regional variation in LTP rates in 9 large geographic regions. MAIN OUTCOMES AND MEASURES: Rate of LTP per 10 000 Medicare beneficiary person-years and per 10 000 diagnosed open-angle glaucoma (OAG) person-years. RESULTS: The LTP rates per 10 000 Medicare beneficiary person-years were 36.3, 60.1, and 53.5 for 2002, 2006, and 2009, respectively. The 65.6{\%}increase between 2002 and 2006 and the 11.0{\%} decrease between 2006 and 2009 were statistically significant (tests for linear trend, P = .009 and P <.001, respectively). Similarly, the LTP rate among Medicare beneficiaries with OAG increased from 507.9 per 10 000 person-years in 2002 to 824.3 per 10 000 person-years in 2006 (62.3{\%} increase; P = .009) and then decreased to 741 per 10 000 person-years by 2009 (10.1{\%} decrease; P = .004). The rates per 10 000 OAG person-years differed significantly by region, ranging from 314 in the East South-Central region to 607 in the East North-Central region in 2002 (93.2{\%} higher; P <.001). A similar range of variation was observed in subsequent years. CONCLUSIONS AND RELEVANCE: The rate of LTP for Medicare patients with OAG peaked in 2006 and then decreased through 2009. Nearly twice as many LTP procedures per Medicare beneficiary were performed in some regions compared with others throughout the period.",
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AU - Cassard, Sandra

AU - Friedman, David S

AU - Shekhawat, Nakul S.

AU - Whiteside-de Vos, Julia

AU - Quigley, Harry A

AU - Gower, Emily W.

PY - 2014

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N2 - IMPORTANCE: Laser trabeculoplasty (LTP) is routinely used to treat open-angle glaucoma; hence, understanding variations in its use over time and region is important. OBJECTIVE: To determine trends over time and the regional variation in the performance of LTP. DESIGN, SETTING, AND PARTICIPANTS: Database analysis of a 5%random sample of all Medicare beneficiaries 65 years or older with continuous Part B (medical insurance) coverage and no enrollment in a health maintenance organization for each year from 2002 through 2009. INTERVENTIONS: We counted unique claims with a Current Procedural Terminology code of 65855 (LTP) submitted by ophthalmologists, optometrists, ambulatory surgery centers, or outpatient hospitals by region for each year.We examined trends over time and regional variation in LTP rates in 9 large geographic regions. MAIN OUTCOMES AND MEASURES: Rate of LTP per 10 000 Medicare beneficiary person-years and per 10 000 diagnosed open-angle glaucoma (OAG) person-years. RESULTS: The LTP rates per 10 000 Medicare beneficiary person-years were 36.3, 60.1, and 53.5 for 2002, 2006, and 2009, respectively. The 65.6%increase between 2002 and 2006 and the 11.0% decrease between 2006 and 2009 were statistically significant (tests for linear trend, P = .009 and P <.001, respectively). Similarly, the LTP rate among Medicare beneficiaries with OAG increased from 507.9 per 10 000 person-years in 2002 to 824.3 per 10 000 person-years in 2006 (62.3% increase; P = .009) and then decreased to 741 per 10 000 person-years by 2009 (10.1% decrease; P = .004). The rates per 10 000 OAG person-years differed significantly by region, ranging from 314 in the East South-Central region to 607 in the East North-Central region in 2002 (93.2% higher; P <.001). A similar range of variation was observed in subsequent years. CONCLUSIONS AND RELEVANCE: The rate of LTP for Medicare patients with OAG peaked in 2006 and then decreased through 2009. Nearly twice as many LTP procedures per Medicare beneficiary were performed in some regions compared with others throughout the period.

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