Real-World Versus Centers for Medicare and Medicaid Services Estimates of Pediatric Retinal Detachment Repair Times

Purpose: To compare real-world pediatric retinal detachment (RD) repair times with the Centers for Medicare and Medicaid Services (CMS) estimates for complex RD surgeries. Methods: A cross-sectional survey was performed of complex pediatric RD perioperative times from pediatric retina specialists across the United States. Results: A total of 152 patients were included. The mean (±SD) age at the initial visit was 9.2 ± 5.8 years, and the mean (±SD) follow-up was 2.31 ± 1.95 years. The most common complex pediatric RD surgeries were pars plana vitrectomy (PPV) (61%, n = 92), followed by combined scleral buckle (SB)/PPV (21%, n = 32) and SBs (20%, n = 30). Surgeries were most commonly performed at hospitals (66%, n = 104), which were associated with longer intraoperative times than in ambulatory surgery centers (median, 150 minutes vs 121 minutes; P = .004). The most common medical insurance was Medicaid (49%). There was a median of 135 minutes (interquartile range [IQR], 74–200 minutes) of uncompensated physician time for patient phone calls, contacting insurances, and surgery turnover for each patient. Combined preoperative pediatric surgery times were longer in the real-world survey than CMS estimates (median, 92 minutes [IQR, 67.5–120 minutes] vs 63.5 minutes [IQR, 51.5–64 minutes]; P < .001). Real-world intraoperative times were also higher than CMS estimates (median, 141 minutes [IQR, 110–192 minutes] vs 133 minutes [IQR, 120–138 minutes]; P = .003). Approximately 38% of patients needed another surgery postoperatively, most commonly another RD repair (63%). Conclusions: Pediatric RD repairs may be undervalued by CMS estimates. The intraoperative times were longer, and physicians spent an extra 2.25 hours of uncompensated time caring for each child in the perioperative period. The current reimbursements may not fully account for the complexity and length of perioperative care for pediatric RDs.