Variations in Cataract Extraction Rates in Medicare Prepaid and Fee-for-Service Settings

Also examines variation in the use of procedures--this time, cataract extraction in Medicare prepaid and fee-for-service (FFS) settings. The study was based on a cross-sectional analysis using 1993 Medicare claims and encounter files. The main outcome was age and risk-adjusted rates of cataract extraction per 1,000 beneficiary-years. After controlling for age, sex, and diabetes status, the authors found that FFS beneficiaries were twice as likely to undergo cataract extraction as were prepaid beneficiaries, and that female FFS beneficiaries were nearly twice as likely to undergo the procedure as were male FFS beneficiaries. These huge differences in performance of cataract surgery between managed care and fee-for-service systems deserve further clinical investigation to determine whether there is overuse in the FFS system, or underuse in the prepaid settings. Such investigations must assess the appropriateness of cataract surgery by evaluating its use relative to clinical need. This article, like the previous article, calls for the performance of detailed clinical studies to determine the relative amount of over- and underuse in the FFS and managed care settings.