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This article was originally published in The Gray Sheet

Executive Summary

CATARACT SURGERY WAS APPROPRIATE IN UP TO 84% OF MEDICARE PATIENTS who underwent the procedure, according to the results of a patient survey conducted by the General Accounting Office at the request of Senate Aging Committee Chairman David Pryor (D-Ark.) and released on April 21. "About three-quarters of Medicare patients reported one or more substantial functional impairments affecting their ability to drive, read or watch television prior to their cataract surgery," GAO states, adding that "these responses generally support the appropriateness of the procedure for these patients." Furthermore, the report continues, "with the inclusion of symptoms such as blurred vision or sensitivity to glare, the proportion of patients with substantial presurgical vision problems increased to 84%." For the remaining 16%, GAO notes, "surgery may have been more questionable...depending on the weight given to 'slight' symptoms and functional limitations relative to the risks of the surgery." Cataract surgery is the largest single procedure reimbursed by Medicare. In 1991, the program paid $3.4 bil. for approximately 1.3 mil. surgeries. The expenditures accounted for roughly 3% of total Medicare outlays. The survey was intended to obtain patient assessments of their symptoms and functional impairments both before and after surgery. A total of 1,964 questionnaires were mailed to a random sample of Medicare beneficiaries in California, Massachusetts, Pennsylvania and Texas. GAO obtained usable responses from 1,488, or 76%. "With respect to the long-term outcomes of the surgery, the overwhelming majority of respondents reported that they improved on one or more symptoms and functional impairments," the report states. "For about two-thirds, this improvement was uniform across all dimensions (that is, the symptoms and functions that did not get better at least stayed unchanged). Most of the other patients reported mixed results, with improvements in some symptoms or functional impairments and worsening in others."

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