Healthcare System Cost Analysis of Common Ophthalmic Procedures Performed in an Operating Room Versus an Office Procedure Room.

PURPOSE: To compare the reimbursements associated with posterior blepharoptosis, ectropion, entropion, pterygium, and chelation for band keratopathy surgeries performed in an operating room versus an office procedure room and assess the potential benefit of incentivizing the use of the more cost-effective option.

DESIGN

Economic analysis.

METHODS

The 2022 Centers for Medicare and Medicaid Services database was used to determine the reimbursement for each procedure when performed in the operating room and office procedure room. Total services for each procedure were aggregated and used to estimate the total cost to the healthcare system based on location.Overhead costs for office procedures were calculated by examining the 3 main costs associated with these office procedures: disposables, human resources, and physical facilities.An incentive analysis was performed, which involved calculations examining the change in annual cost to Medicare if the reimbursement for the study procedures were increased to include overhead costs and various incentive payment percentages.

RESULTS

Procedures performed in the operating room cost an average of $2200 more than office procedures. The average overhead cost for office procedures was $150. The total cost of the study procedures in 2022 was $177 million, with >90% of procedures performed in the operating room. Increasing reimbursement by 150% the cost of overhead, when 50% of procedures are performed in the office, saves the healthcare system $52 million.

CONCLUSIONS

Increasing office reimbursement to cover overhead costs and provide a small incentive to perform procedures in the office could save the healthcare system millions of dollars.