Access to retina providers shows no geographic bias in US
PHILADELPHIA — Access to retina care in the United States shows no geographic bias, a study found.
A retrospective cross-sectional review of a 2016 Medicare data set merged with Census Bureau, IRS and CDC data sets aimed to identify where retina specialists or hybrid providers who provide retina treatment practice throughout the country.
“We know the incidence of diabetic retinopathy and age-related macular degeneration is increasing due to multiple demographic changes. In the modern era many of these cases, including other retina vascular conditions as well, are highly responsive to anti-VEGF or laser treatments,” Ravi R. Pandit, MD, MPH, said at the annual Wills Eye Conference. “Delivering these treatments in a technically proficient and evidence-based way requires proper training and experience, which dovetails into this idea of access to quality health care.”
Ophthalmologists who performed anti-VEGF injections, focal laser therapy or retinal photocoagulation were identified as retina providers through the Medicare data. Those who also performed YAG capsulotomies in the same year were identified as comprehensive or hybrid providers.
A total of 17,238 ophthalmologists were identified, with 3,329 of them being retina providers. Of those, 1,034 were considered hybrid providers and the rest were considered retina specialists.
A previous study found that 90% of Americans live within a 25-minute drive of an ophthalmologist. Overall, access to retina providers is consistent with access to ophthalmologists in general.
“There was nothing in terms of regional variation that predicted the presence of a retina provider. This gives us some reassurance that in terms of all retina providers, there’s not really a geographic bias in this country,” Pandit said.
The study authors then looked at the geographic and practice differences between retina specialists and hybrid providers.
Retina specialists were more likely to be located in affluent areas with lower diabetic burden, while hybrid providers were more likely to be in locations with older populations and lower adjusted mean gross income.
“On average, the hybrid practitioners treated fewer Medicare beneficiaries, offered fewer injections per beneficiary per eye and on average were more likely to use off-label intravitreal bevacizumab,” Pandit said. “We find that hybrid providers do practice differently, although obviously we need to assess whether or not this translates to different outcomes.” – by Rebecca L. Forand
Pandit R. Distribution and practice patterns of retina providers across the United States. Presented at: Wills Eye Conference; March 7-9, 2019; Philadelphia.
Disclosure: Pandit reports no relevant financial disclosures.