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Vision Loss Costing Medicare Billions

According to a study titled “Association between Vision Loss and Higher Medical Care Costs in Medicare Beneficiaries,” published in the journal Ophthalmology,¹ poor vision is costing Medicare more than $2 billion per year in [non-eye] related maladies and healthcare needs. As a result, the American Academy of Ophthalmology (AAO) is calling for Medicare and other medical insurance plans to place a stronger emphasis on providing preventive eye care for all Americans.

“We have always understood the devastating personal impact of blinding eye disease on patients and their families,” said Jonathan C. Javitt, M.D., M.P.H., lead researcher on the study conducted by the Potomac Institute for Policy Studies, the Wilmer Eye Institute at Johns Hopkins University and Pfizer, Inc. “With this study, we are seeing the serious economic impact of poor vision health on the healthcare system and those who pay for it.”

The Academy and Dr. Javitt said the study is a chance for the Centers for Medicare and Medicaid Services (CMS) to build on its landmark Medicare Glaucoma Detection Act of 2001, which covers an annual glaucoma screening for patients at risk, as well as its coverage of eye exams for diabetics, which has been available since 1998. However, awareness of these benefits is low. For example, fewer than 45% of Medicare diabeticshave had an eye exam.

“Medicare has already taken an important first step in making screenings available for those who are most at risk,” Dr. Javitt said. “‘CMS’ ‘welcome to Medicare’ physical examination should make vision assessment a key component of these visits with primary care physicians.”

The study, which looked at a 5% sampling (approximately 1.5 million people) of Medicare beneficiaries continuously enrolled from 1999 to 2003, concluded that those with moderate, severe and total vision loss experienced increases in depression, injuries and the need for nursing home facilities.

The study also showed Medicare beneficiaries with coded diagnoses of vision loss incurred significantly higher costs than those with normal vision, and approximately 90% of those costs were non-eye related.

Extrapolating to the entire Medicare population, blindness and vision loss are associated with $2.14 billion in 2003 non-eye related medical costs, says Dr. Javitt. He said those with moderate loss, severe loss and blindness had annual non-eye related costs of $2,193, $3,301 and $4,443, compared to the costs of those with normal vision.

According to the study, $460 million was associated with those with existing vision loss and $1.68 billion was associated with those who developed vision loss during the study period. For those with newly developed vision loss, the adjustment to the new eye disorder may have contributed to the increased costs for depression, injuries and the need for skilled nursing home assistance.

More than half of the cases were due to age-related macular degeneration (AMD) and glaucoma. A sizable number of cases of vision loss were due to cataracts that had not been surgically removed.

“These are all treatable conditions. If identified early, the adverse effects of glaucoma and AMD can be minimized, and cataracts can easily be treated,” said H. Dunbar Hoskins, M.D., executive vice president for the AAO. “With the results of this study, it is clear that taking care of your eyesight is not only in the best interest of patient health, but it also is a benefit to the country’s Medicare system.” OM

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