Are intravitreal injections costing your practice money? Christina Weng, MD, from the Cullen Eye Institute at the Baylor College of Medicine in Houston, figures yes.
Dr. Weng calculates each injection, regardless of the drug being injected, costs $127.74, broken down as $1.60 for materials, $97.88 for labor, and $28.28 for overhead. And in 2018, Medicare only reimbursed $104.40 for the procedure. So for every injection, a practice was eating $23.34.
According to Dr. Weng, a mid- to high-volume practice does 20-50 injections daily, so the amount of money lost can be significant. Smaller practices can see the cost as well, as they don’t have the ability to spread the overhead costs out as much as larger practices.
Dr. Weng decided to make the cost analysis because the Common Procedural Terminology code for intravitreal injection is closely scrutinized by regulators to make sure that physicians are not being overpaid for that common procedure.
But when she timed the procedure in her practice for 14 patients who came in for an injection-only appointment and added in the associated costs, she determined that they were actually being underpaid.
Part of the problem might stem from an undervaluation when physicians are asked about costs by the Relative Value Scale Update Committee, who make recommendations to the American Medical Association, which then makes recommendations about the value of new and revised CPT codes to the Centers for Medicare and Medicaid Services, Dr. Weng hypothesizes. Physicians picture the injection as a 2-minute process, but her study put the total time related to the procedure at 32 minutes and 58 seconds.
“When you add up the time between charting, ordering up the medication, getting the patient prepped — maybe not by the physician but by staff — those are all costs involved in the procedure,” Weng said.
These numbers are from one physician in one practice, but Weng hopes others will assess costs in their own practices so that an accurate national reimbursement figure can be determined.
Dr. Weng’s findings were presented at the American Society of Retina Specialists 2019 Annual Meeting.