A cost-analysis of unilateral vs. simultaneous bilateral cataract surgery in Canada

Purpose: To identify and measure the cost differences surrounding unilateral and simultaneous bilateral cataract surgery in the larger population centers of Canada in order to understand financial factors that may encourage or discourage the performance of simultaneous bilateral cataract surgery. Methods: Physician schedules of benefits from the four provinces in Canada with the largest populations, were applied to a basic template of patients undergoing unilateral and bilateral cataract surgeries. The data was analyzed for similarities and differences to identify financial factors that may influence stakeholders toward or away from simultaneous bilateral cataract surgery. Results: Simultaneous bilateral cataract surgery had a 15% to 30% greater efficiency in terms of the numbers of eyes that can be operated on per day. The ophthalmologist's surgical fee is discounted for the second eye surgery of simultaneous bilateral cataract surgery in varying amounts in different provinces, from no discount in Quebec to 50% in British Columbia. Financial incentive issues are compounded by differing reimbursement schemes for unilateral surgery across regions. Anesthesiologists are generally reimbursed for bilateral cataract surgeries through additional time units of pay, not by additional surgical complexity, and overall earn less with unilateral cataract surgeries. For the institution, bilateral cataract surgeries offer greater administrative, laboratory and nursing efficiencies with minimal increases in overall complexity. Conclusions: Discounting of the second eye surgery in simultaneous bilateral cataract surgery acts as a financial deterrent to the ophthalmologist for its adoption, while increased efficiency may offer a counterbalancing incentive to the ophthalmologist and surgical centre, whereas anesthesiologists generally experience financial disincentives in simultaneous bilateral cataract surgery.