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Abstract

Background: In recent decades, many physicians have chosen to opt out of Medicare, allowing them to set their own pricing models for their patients. Characterization of Medicare opt-outs has not been thoroughly studied in any surgical specialty, including ophthalmology.

Purpose: To characterize the factors that may influence an ophthalmologist's decision to opt out of Medicare acceptance and contextualize them both within the field and across various surgical specialties.

Methods: Retrospective cross-sectional analysis using Centers for Medicare and Medicaid Services (CMS) data on starting date of physician opting out as well as geographic state of practice for ophthalmologists and other specialty surgeons. Additional parameters were collected from publicly available profiles of ophthalmologists regarding medical school graduation year, subspecialty, and type of practice.

Results: 72 ophthalmologists opted out of Medicare. The rate of Medicare opt-outs was highest for ophthalmology and most surgical specialties between the years 2015 and 2017. 83.3% of opt-out ophthalmologists were exclusively private practice physicians while 8.3% practiced only in academic medicine and another 8.3% practiced in a mix of both private and academic settings. Most were comprehensive (33.3%), cornea and refractive surgery (26.4%), or oculoplastics specialists (20.8%). Most Medicare non-participating ophthalmologists chose to opt out in their mid-career compared to early or late career. A higher number of these ophthalmologists were located in the Southwest United States, particularly in Oklahoma, New Mexico, and Kansas.

Conclusions: The circumstances influencing an ophthalmologist’s decision to opt out of Medicare acceptance are multifaceted, and our findings suggest that physician experience, specialty, location, and practice structure may all play roles and should be further investigated.

Received Date

28-Dec-2023

Accepted Date

23-Aug-2024

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