Medicare Widens Options for Cataract Surgery
Corrective Replacement Lens Is Allowed for Seniors Able To Pay an
By Rhonda L. Rundle
11 May 2005
Medicare has changed its rules so that senior citizens
who undergo cataract surgery will be able to opt for a high-tech
replacement lens that also corrects reading vision. The change,
announced on Medicare's Web site yesterday, represents a policy
shift that could widen access to other cutting-edge medical technologies
for patients covered by the federal health insurance plan for the
elderly. The lenses are considered a significant advance in vision
correction but hadn't been available to Medicare patients until
now. Surgeons who use the implants have been offering them to younger
patients willing to spend perhaps $4,500 an eye, but they couldn't
offer them to Medicare patients, who constitute the vast majority
of people undergoing surgery for cataracts. Under the old rule,
surgeons weren't permitted to charge Medicare patients for the difference
between the cost of a conventional cataract surgery, which uses
an older type of lens to replace the eye's natural lens, and a similar
procedure that uses the new implant. Medicare pays about $2,000
for a standard cataract surgery, including the lens and fees for
the facility and the surgeon. Now, Medicare patients willing to
spend an extra $2,500 or so of their own money can get one of the
new lenses instead.
"This is an Emancipation Proclamation for Medicare
patients," declared Jeffrey Whitman, a Dallas eye surgeon who
has implanted about 600 of the new lenses. "We have had to
tell Medicare patients that this isn't for you, it's for everybody
else. Now we can be nondiscriminatory."
More cataract procedures are performed in the U.S. and world-wide
than almost any other type of surgery. A cataract is an age-related
cloudiness that occurs in the lens of the eye. The rule change recognizes
that the new lenses treat two distinct medical conditions: one that
is covered by the Medicare program, cataracts, and one that isn't,
presbyopia, the loss of near vision that typically requires people
to use reading glasses by the age of 45 or so.
"This is a model we can continue to use and explore when it
fits into the category" of a technology upgrade, said Leslie
Norwalk, deputy administrator at Medicare, in an interview. "There
may be other technologies that come down the road where this approach
may make sense -- we will have to wait and see."
Ms. Norwalk said legal issues had slowed the agency's decision
to make the cataract-surgery policy change. The agency wanted to
allow patients to purchase upgraded lenses, but at the same time
wanted to protect beneficiaries from unethical surgeons who might
try to bill patients more for conventional cataract surgeries. The
decision is a giant boost for companies that make the new lenses
and the surgeons who are implanting them.
Dr. Whitman uses the Crystalens, made by Eyeonics Inc., a closely
held company in Aliso Viejo, Calif.
The Food and Drug Administration recently approved Alcon Inc.'s
The companies were ecstatic about the news.
"This is clearly the biggest decision in our small company's
life -- it expands our market four or five times," said Andy
Corley, chief executive officer of Eyeonics. "We believe this
is a win-win for everybody."
"This is a major event for Alcon as well as competitors who
are developing and/or marketing intraocular lenses with a presbyopic
refractive component," said Peter Bye, an analyst at Citigroup
Smith Barney who upgraded his rating on Alcon's stock. The analyst
said the ruling increases the market potential for such products
to 2.8 million procedures in the U.S. this year, five times what
had been expected. The decision opens the door to cataract surgeons
to promote the technology to their Medicare patients. For surgeons,
such procedures are significantly more lucrative than conventional
Dr. Whitman says the higher fees reflect the much more time-consuming
measurements and postoperative care that such patients need. Using
the new lenses is "more akin to refractive [vision correction]
surgery than cataract surgery" because of patient expectations
for excellent vision, he said.
Eyeonics has been trying for five years to get the Medicare rule
changed, said Mr. Corley. "There were high-level meetings,
but they kept delaying and delaying," he said. The matter received
more attention after U.S. Rep. Christopher Cox, a California Republican,
"It was a Catch-22 situation because Medicare would pay for
cataract surgery and a lens, but it wouldn't pay for cataract surgery
with a product that was meant to be in lieu of the [standard] lens,"
Rep. Cox said in an interview. "Federal policy should not discourage
technological advance," he added.