How Much Does Cataract Surgery Cost?

By Michael J. Dodd, MD

Maryland Eye Associates

. http://marylandeyeassociates.com

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How Much Does Cataract Surgery Cost?

Surgery to remove cataracts from the eye with insertion of an artificial lens implant is one of the most common operations performed in the United States. It is estimated that approximately 3.2 million cataract operations are performed yearly and this number is increasing with the aging population. Most patients who have cataract surgery are enrolled in Medicare.

Cataract surgery can be performed in a hospital or in an Ambulatory Surgery Center (ASC). Today most cataract surgeries are performed in ASCs because of safety and cost considerations. Cataract surgeries have been performed in ASCs since the late 1970s. Because of safety and cost issues and because patients no longer spend the night in a hospital before and after cataract surgery, Medicare has encouraged that cataract surgery be performed in ASCs. In 2009 cataract surgery was the single most common procedure performed in ASCs on Medicare patients.

As most Medicare beneficiaries are aware, Medicare will pay up to 80% of physician fees, 80% of hospital or ASC costs, and 80% of anesthesia costs. The hospital or ASC cost is called the “facility fee.” The facility fee covers the cost of the operating room, the staff costs and the cost of any disposables and a standard lens implant. The patient is responsible for the 20% of the facility fee that is not covered by Medicare. Many patients have “co-insurance” with AARP, Blue Cross, United Health Care, or others which will pay all or part of the “co-insurance.” The amount that a patient must pay “out of pocket” is also dependent on where the cataract surgery is performed. The physician fee is the same wherever the procedure is performed.

But some patients do not realize the considerable cost differences between surgery in a hospital or surgery in an ASC. At a community hospital in our area in southern Maryland, the facility fee paid to the hospital for a routine cataract surgery is about $3,500. If a patient has no co-insurance, they are responsible for 20% or $700 out of pocket.

At an ASC in the same community, the facility fee for the same surgery is about $1000 and the patient co-insurance is 20% or $200. This is a huge savings for the patient (and for Medicare) when surgery is performed at an ASC. You can see why Medicare favors that cataract surgery be performed in ASCs.

What about safety? There have been many studies over the years, which concluded that infection rates are lower in ASCs compared to hospitals for cataract surgery. Why would this be? Remember, hospitals have a huge variety of patients, most of whom stay overnight and many of whom are very sick. Some of these patients may carry infectious organisms. Infections in hospitals (called nosocomial infections) can spread among overnight patients and even among staff. In addition, hospitals perform many types of surgery among many types of specialties, whereas many ASCs perform only eye surgery. Eye surgery is considered “clean” and less likely to be associated with infections. Finally, there are no overnight patients in ASCs. These reasons are thought to contribute to the lower infection rate for cataract surgery in ASCs compared to hospitals. Fortunately, infections are rare after cataract surgery, wherever performed, but in ASCs the rates are lower.

Many ASCs are completely or partially owned by the physicians who perform surgery at the facility. This is beneficial to the patient because the doctors can choose the best nurses, personnel and equipment. In hospitals these decisions are made by others. So if your surgeon is on the staff of an ASC this works to your benefit, both financially and with lower infection rates. If you are having your cataract surgery at a hospital you may want to ask why.