Physician payments for strabismus surgery versus cataract surgery across provinces and territories in Canada
Authors: Kaylin Moira O'Hara1, Vishaal Bhambhwani2. 1McMaster, 2Northern Ontario School of Medicine.
Author Disclosures: K.M. O'Hara: None. V. Bhambhwani: Funded grants or Clinical Trials; Name of for-profit or not-for-profit organization(s); Northern Ontario Academic Medicine Association, Orbis Canada. Funded grants or Clinical Trials; Description of relationship(s); Grant support.
Abstract Body:
Purpose: Inadequate financial reimbursements in pediatric ophthalmology and strabismus and higher compensation in other subspecialties have been determined to be major causes for declining interest of ophthalmology graduates in this subspecialty, leading to serious workforce concerns. We review physician reimbursements for strabismus surgery and compare them to cataract surgery across provinces and territories in Canada.
Study Design: Literature Review
Methods: The manuals for physician remuneration for all provinces and territories in Canada were reviewed; strabismus surgery and routine cataract surgery billing codes with their respective compensation values were extracted. Strabismus surgery and routine cataract surgery reimbursement codes were compared amongst all provinces and territories. The data was analysed using appropriate statistical tests.
Results: 1 to 5 muscle strabismus surgery reimbursement rates by province/territory were: Ontario $369-542; Newfoundland $369-542; British Columbia $374-765; Nova Scotia $436-799; Prince Edward Island (PEI) $475; Quebec $498-1202; Saskatchewan $455-1146; Manitoba $523-1723; New Brunswick $714; Alberta $706-1412; Northwest Territories $543-1176; Yukon $835-1083. Thus, physician reimbursements for 1-muscle strabismus surgery ranged from $369 (Ontario, Newfoundland) to $835 (Yukon), and for 5-muscle strabismus surgery from $475 (PEI) to $1723 (Manitoba) [ANOVA test statistically significant, p=0.00001]. Only 6 out of 12 provinces/territories had special/higher payment codes for complex strabismus procedures. 2/12 did not reimburse for adjustable sutures. 3/12 did not have special payment codes for re-operations. Mean physician reimbursement for 1-muscle strabismus surgery versus routine cataract surgery across provinces and territories was $525 (range: $369-$835) and $522 (range: $325-$965), respectively (t test not statistically significant, p=0.97). 5 out of 12 (42%) provinces/territories paid physicians less for 1-muscle strabismus surgery compared to routine cataract surgery.
Conclusions: There exists high variability in physician payments for the same strabismus procedures across provinces/territories in Canada; with Ontario, Newfoundland, and PEI being the lowest payors. Many provinces pay physicians more for cataract surgery versus strabismus surgery despite the usual need for general anesthesia for the latter, with its effects on physician time/effort for surgery and pre/post-operative care. These reimbursement issues may be leading to declining interest in the subspecialty of pediatric ophthalmology and strabismus amongst ophthalmology residents.
X
