Medicare payments and changes in the rate of cataract extraction.

The influence of Medicare payments on cataract extraction was studied. This operation is now the most frequent one performed on Medicare beneficiaries. The rate per 1,000 has more than doubled. The aggregate number of operations has tripled since 1965. As the number of persons over 65 has only increased by 27% in that time and the number of ophthalmologists by 25%, it is evident that each surgeon is doing more cases. Analysis of two representative years of Medicare's payment records indicated that many more surgeons received high payments in 1977 than in 1972. This reflected an increase in fees, but also an increased number of cases. Just over 2% of surgeons received more than $75,000 for cataract surgery on Medicare beneficiaries. The suggested reasons for the findings are an absence of mutually accepted criteria for cataract extraction, Medicare's fee system, and public attitudes.