title: Patient and physician perceptions of medicare reimbursement policy for blepharoplasty and blepharoptosis surgery.
abstract: OBJECTIVE
  To describe patient preferences regarding payment for blepharoplasty and blepharoptosis repair and physician practices before and after the 2009 change in reimbursement for these 2 procedures by the Centers for Medicare and Medicaid Services (CMS).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Fifty patients presenting for functional blepharoplasty and blepharoptosis repair at an academic oculoplastic practice and 198 members of the American Society of Ophthalmic Plastic and Reconstructive Surgery.
  
  
  METHODS
  A 5-question paper survey was administered to patients, and a 5-question web-based survey was distributed to 510 unique physician e-mail addresses obtained from the American Society of Ophthalmic Plastic and Reconstructive Surgery mailing list server in 2010.
  
  
  METHODS
  The surveys elicited patient knowledge and attitudes regarding the reimbursement policy of the CMS and physician knowledge and behaviors before and after the reimbursement policy change.
  
  
  RESULTS
  Ninety-one percent of patients would be opposed to having to pay out of pocket for blepharoplasty or having to wait at least 3 months after ptosis repair to have a blepharoplasty. When asked to choose between these options, 62% of the patients would rather have the 2 surgeries performed separately than pay out-of-pocket. Before the reimbursement policy change by the CMS, 77% of oculoplastic surgeons performed blepharoplasty and blepharoptosis repair in the same sitting, whereas 37% did so after the policy change (P<0.001). Compared with before the policy change by the CMS, more surgeons performed the 2 procedures at least 3 months apart (4% before vs. 29% after, P<0.001) and more often billed patients for a cosmetic blepharoplasty (5% before vs. 12% after, P = 0.009).
  
  
  CONCLUSIONS
  Our study suggests that oculoplastic surgeons have made a change in the delivery of ptosis and blepharoplasty surgical services after the reimbursement policy change for these procedures by the CMS in 2009. This change, in which patients undergo separate surgical visits for ptosis repair and blepharoplasty, is not desirable to most patients.
authors.affiliation: Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota.
authors.forename: Jasmina
authors.initials: J
authors.lastname: Bajric
authors.affiliation: Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Levin
authors.affiliation: Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota.
authors.forename: George B
authors.initials: GB
authors.lastname: Bartley
authors.affiliation: Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota. Electronic address: bradley.elizabeth@mayo.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bradley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000191:economics*; D001763:Blepharoptosis / Q000601:surgery*; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000331:legislation & jurisprudence; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D009885:Ophthalmology / Q000458:organization & administration; D057240:Patient Preference / Q000706:statistics & numerical data; D010361:Patients / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000191:economics / Q000331:legislation & jurisprudence*; D012955:Societies, Medical; D014481:United States