The Prevalence of Diagnosis of Major Eye Diseases and their Associated Payments in the Medicare Fee-for-Service Program

ABSTRACT

Purpose

To estimate the prevalence of diagnosis of major eye disorders and their associated payments, in total and per-person diagnosed, among Medicare fee-for-service (FFS) beneficiaries in 2018.

Methods

We analyzed 100% Medicare Part B FFS claims and Part D Events among beneficiaries continuously enrolled for 12 months in 2018 to calculate the proportion of beneficiaries with ≥1 claim indicating age-related macular degeneration (AMD), cataract, diabetic retinopathy (DR), or glaucoma, and their associated payments, including Medicare and patient out-of-pocket. Eye disease and eye care services were identified using case definitions from the Centers for Disease Control and Prevention’s (CDC) Vision & Eye Health Surveillance System (VEHSS). Outcomes are reported by disease overall and by age group (0–39, 40–64, 65–84, 85+ years), sex, race/ethnicity, and U.S. state.

Results

Among nearly 30 million Medicare Part B FFS beneficiaries in 2018, over 41% (12.4 million) had a claim containing a diagnosis of at least one of the four eye disorders; 33.7% with cataract, 13.3% with glaucoma, 9.2% with AMD and 3.2% with DR. Payments for eye care services and drugs associated with these four conditions were $10.1billion; $3.6 billion for cataract, $3.5 billion for AMD, $2.2 billion for glaucoma and $0.8 billion for DR. The average cost per beneficiary diagnosed was $816: $1,290 for AMD, $781 for DR, $543 for glaucoma, and $360 for cataract.

Conclusions

Major eye disorders are common among Medicare FFS beneficiaries and account for approximately 4.3% of Medicare Part B and 1% of Medicare Part D spending.

KEYWORDS:

• AMD
• age related macular degeneration
• cataract
• cost
• diabetic retinopathy
• eye
• glaucoma
• medicare
• ophthalmic
• payment
• preva lence
• vision

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Disclosure statement

See COI Declaration.

Financial support

This manuscript was supported by funding from the CDC Vision Health Initiative via contract 200-2014-61264-0006, “Developing an Online Toolkit to estimate State Specific Economic Burdens Attributable to Vision Loss and Eye Diseases in the United States”.

Additional information

Funding

This work was supported by the Centers for Disease Controls and Prevention (CDC) [200-2014-61264-0006].