Pressures to control costs have increased substantially over the past several years. As health care costs have increased and capitation has become more common, those pressures have increasingly been felt and applied by the government, large employers and other payers, the providers of health care, and, of course, patients. Cataract surgery, the most frequently performed procedure for Medicare beneficiaries, accounts for $3.4 billion dollars annually or approximately 12%1 of Medicare Part B payments. Furthermore, YAG capsulotomy is now the second most commonly performed procedure for Medicare beneficiaries, and argon laser trabeculoplasty and retinal photocoagulation for diabetic retinopathy are among the 10 most common procedures received by this population. Not surprisingly, there has been tremendous scrutiny and targeting of cost containment toward ophthalmology in general and cataract surgery in particular.
Further cost-containment efforts related to cataract surgery are inevitable. Ophthalmologists, however, have both an opportunity and a choice related to