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.

中文翻译：

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Medicare 按服务收费计划中主要眼病的诊断率及其相关费用

摘要

目的

估计 2018 年 Medicare 按服务收费 (FFS) 受益人中主要眼部疾病的诊断流行率及其相关支付，包括总数和每名诊断者。

方法

我们分析了 2018 年连续登记 12 个月的受益人中 100% Medicare B 部分 FFS 索赔和 D 部分事件，以计算 ≥1 项索赔表明年龄相关性黄斑变性 (AMD)、白内障、糖尿病性视网膜病变 (DR) 的受益人比例或青光眼及其相关费用，包括医疗保险和患者自付费用。使用疾病控制和预防中心 (CDC) 视力和眼部健康监测系统 (VEHSS) 的病例定义确定了眼病和眼保健服务。结果按总体疾病和年龄组（0-39、40-64、65-84、85 岁以上）、性别、种族/民族和美国各州报告。

结果

在 2018 年近 3000 万医疗保险 B 部分 FFS 受益人中，超过 41%（1240 万）的索赔包含四种眼部疾病中至少一种的诊断；33.7% 患有白内障，13.3% 患有青光眼，9.2% 患有 AMD，3.2% 患有 DR。与这四种情况相关的眼保健服务和药物费用为 101 亿美元；白内障 36 亿美元，AMD 35 亿美元，青光眼 22 亿美元，DR 8 亿美元。每个被诊断的受益人的平均费用为 816 美元：AMD 为 1,290 美元，DR 为 781 美元，青光眼为 543 美元，白内障为 360 美元。

结论

主要眼部疾病在 Medicare FFS 受益人中很常见，约占 Medicare B 部分支出的 4.3% 和 Medicare D 部分支出的 1%。