Home E-Weekly April 18, 2017

Eliminate Pre-op Testing for Cataract Patients, Save $500 Million

Published: April 17, 2017

BLOOD LOSS Cataract patients who need blood work and other pre-op testing can be identified with a checklist, says Peter Provonost, MD, PhD.

Want to save half a billion dollars a year? Eliminate the requirement that cataract surgery patients be subjected to electrocardiograms, blood tests, imaging studies and other routine pre-operative testing. That, says Peter Provonost, MD, PhD, would result in enormous saving "with no negative effect on patient health."

Writing in the Wall Street Journal, Dr. Provonost, an anesthesiologist and critical-care physician at Johns Hopkins, points out that the risks associated with such testing are rare in cataract surgery. The rare exceptions — those who truly need preoperative workups — can easily be identified with checklists, he says.

Moreover, no such requirement exists for dental procedures, most endoscopies and office-based minor procedures, he points out. But the federal government and accrediting organizations continue to require such testing before every cataract surgery, the most common procedure for Medicare beneficiaries.

Ensuring patient safety is important, says Dr. Provonost, but a more "nuanced approach" based on medical evidence and expertise is called for to reduce compliance burdens and unnecessary expenses related to cataracts and other procedures. CMS, he says, should focus on identifying and revising or removing regulations that hurt clinician productivity, increase costs and burden patients, while providing no clear benefits.

Jim Burger

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