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Medical Malpractice Lawsuits Involving Ophthalmology Trainees

Watane, Arjun; Kalavar, Meghana; Chen, Evan M; Mruthyunjaya, Prithvi; Cavuoto, Kara M; Sridhar, Jayanth; Parikh, Ravi
PMID: 33068616
ISSN: 1549-4713
CID: 4683902

Revisit rates and associated costs after emergency room encounters for ophthalmic conditions [Meeting Abstract]

Azad, A D; Chen, E; Parikh, R; Erickson, B; Mruthyunjaya, P
Purpose : To characterize emergency department (ED) revisit rates related to ophthalmologic conditions, variation by diagnosis, and costs. Methods : We identified 3- and 30-day ED revisit rates by diagnosis, diagnosis categories and demographic groups. Costs associated with revisits were described as a percentage of index visits and adjusted to 2016 US dollars using the Consumer Price Index. We utilized logistic multivariable regression analysis to identify factors significantly associated with revisits. Results : Among a total of 828,125 index ED encounters from 2007-2016 with an ophthalmic condition as a primary diagnosis, the 3- and 30-day revisit for the overall cohort was 2.5% and 4.1% respectively. Conditions of the cornea and external disease comprised the majority of index diagnoses (65.2%) but were associated with low rates of 30-day revisit (3.1%). Thirty-day revisits rates were highest for conditions related to cataract and lens disorders (28.3%) as well as glaucoma (15.9%). Nearly all (99%) patients revisiting the ED with cataract and lens disorders had a cataract-related procedure within 30 days of the index encounter. In multivariable analysis, younger adults, those with insurance plans lacking out-of-network coverage and cases involving an ophthalmologist were associated with a significantly higher likelihood of a revisit within 3-days of an index visit. Conversely, patients with higher out-of-pocket costs during an index visit were significantly less likely to revisit in the same period. Conclusions : Revisit rates for ocular conditions overall are low but varied by diagnosis category. Cataract and lens disorders had the highest 30-day revisit rate (with the vast majority within the 30-day postoperative period) followed by glaucomatous disorders. Younger patients, those with insurance lacking out-of-network coverage, those with lower OOP costs on an index visit and patients with an ophthalmologist participating in their ED care all had higher revisit rates. ED revisits for ocular conditions may be preventable with timely follow-up care, particularly for patients presenting in the acute post-operative period following cataract surgery
ISSN: 1552-5783
CID: 4982232


Parikh, Ravi; Gal-Or, Orly; Sakurada, Yoichi; Leong, Belinda; Freund, K Bailey
PURPOSE/OBJECTIVE:To describe the occurrence of an acquired choroidal nevus in a 73-year-old white man. METHODS:Case report. RESULTS:A 73-year-old white man was referred for an evaluation and treatment of macular changes in his left eye consistent with pachychoroid neovasculopathy. Baseline funduscopic examination and color fundus photographs showed two small peripheral choroidal nevi in the right eye and a single small choroidal nevus in the far temporal macula of the left eye. Treatment with intravitreal aflibercept was initiated in the left eye on a treat-and-extend dosing regimen. Approximately 1 year later, a new pigmented choroidal lesion was detected in the left macula in an area where previous high-resolution color fundus photographs had shown no abnormal pigmentation. Swept-source optical coherence tomography of the new pigmented lesion showed flat hyperreflectivity within the inner choroid consistent with a small choroidal nevus. The patient was referred to his internist who found no evidence of an occult malignancy. Over the course of more than 4 additional years of continuous follow-up, the new choroidal nevus remained stable, no new fundus abnormalities were detected in either eye, and the patient remained medically stable. CONCLUSION/CONCLUSIONS:To the best of our knowledge, this is the first documented case of a new choroidal nevus. Multimodal imaging performed before lesion detection and over the ensuing 4 years showed its stability, thus allowing for the conclusion that it was a benign choroidal nevus rather than a neoplastic or paraneoplastic process.
PMID: 30289791
ISSN: 1937-1578
CID: 3328472

The Impact of International Pricing Index Models on Anti-Vascular Endothelial Growth Factor (VEGF) Drug Costs in the United States

Choi, Stephanie; Chen, Evan M; Chen, Dinah; Sridhar, Jayanth; Parikh, Ravi
OBJECTIVE:To evaluate the impact of three international pricing index models on Medicare Part B spending for intravitreal anti-vascular endothelial growth factor (VEGF) drugs Design: Cost analysis Methods: U.S. and international sales data from the Multinational Integrated Data Analysis (MIDAS) database was used with data from the U.S. Centers for Medicare and Medicaid Services (CMS) to calculate Medicare Part B spending on anti-VEGF drugs Main Outcome: Medicare Part B expenditures of anti-VEGF drugs under various international pricing index models Results: Total Medicare Part B savings was greatest (75%) under the "most favored nation" proposal to peg the U.S. price to the lowest international price. Under the "most favored nation" proposal, prices of aflibercept are reduced from $1825.80 to $507.17, bevacizumab from $74.39 to $27.55, and ranibizumab (3 units or 0.3mg) from $1057.08 to $99.72. CONCLUSION/CONCLUSIONS:International pricing index models are one of many pricing strategies that could lead to savings in Medicare Part B costs.
PMID: 33822670
ISSN: 1744-5205
CID: 4858472

Single-Blind and Double-Blind Peer Review: Effects on National Representation

Kalavar, Meghana; Watane, Arjun; Wu, David; Sridhar, Jayanth; Mruthyunjaya, Prithvi; Parikh, Ravi
Purpose: To assess whether the type of peer-review (single-blinded vs double-blinded) has an impact on nationality representation in journals.Methods: A cross-sectional study analyzing the top 10 nationalities contributing to the number of articles across 16 ophthalmology journals.Results: There was no difference in the percentage of articles published from the journal's country of origin between the top single-blind journals and double-blind journals (SB = 42.0%, DB = 26.6%, p = .49), but there was a significant difference between the percentage of articles from the US (SB = 48.0%, DB = 22.8%, p = .02). However, there was no difference for both country of origin (SB = 38.0%, DB = 26.6%, p = .43) and articles from the US (SB = 35.0%, DB = 22.8%, p = .21) when assessing the top eight double-blind journals matched with single-blind journals of a similar impact factor. The US (n = 16, 100%) and England (n = 16, 100%) most commonly made the top 10 lists for article contribution. This held true even for journals established outside the United States (US=11/12, England = 11/12).Conclusions: There was no significant difference in country-of-origin representation between single-blind journals and double-blind journals. However, higher income countries contributed most often to the journals studied even among journals based outside the US.
PMID: 33760687
ISSN: 1744-5205
CID: 4836712

Economic Challenges of Artificial Intelligence Adoption for Diabetic Retinopathy

Chen, Evan M; Chen, Dinah; Chilakamarri, Priyanka; Lopez, Rieza; Parikh, Ravi
Under current reimbursement models, implementation of IDx-DR may not be financially practical. Adequate reimbursement is necessary to incentivize widespread adoption and realize the potential of automated imaging to increase early detection of diabetic retinopathy.
PMID: 32717340
ISSN: 1549-4713
CID: 4535562

Anti-Vascular Endothelial Growth Factor and Panretinal Photocoagulation Use After Protocol S for Proliferative Diabetic Retinopathy

Azad, Amee D; Chen, Evan M; Hinkle, John; Rayess, Nadim; Wu, David; Eliott, Dean; Mruthyunjaya, Prithvi; Parikh, Ravi
PURPOSE/OBJECTIVE:To characterize the rates of pan-retinal laser photocoagulation (PRP) and anti-vascular endothelial growth factor (anti-VEGF) medications before and after publication of the Protocol S. DESIGN/METHODS:A retrospective, cross-sectional study from January 1, 2012 to September 30, 2019 using a nationally representative claims-based database, Clinformatics™ Data Mart Database (OptumInsight, Eden Prairie, MN). Subjects, Participants, and/or Controls: Eyes newly diagnosed with proliferative diabetic retinopathy (PDR), continuous enrollment, and no prior treatment with PRP or anti-VEGF. Methods, Intervention, or Testing: Interrupted time series regression analysis was performed to identify the annual change in treatment rates before and after the publication of Protocol S (November 24, 2015). MAIN OUTCOME MEASURES/METHODS:Annual rates of anti-VEGF or PRP treatments per 1,000 treated eyes with PDR. RESULTS:From 2012 to 2019, 10035 PRP or anti-VEGF treatments were given to 3685 PDR eyes. 63.6% (6379) of these were anti-VEGF agents and 36.4% (3656) were PRP treatments. 88.7% of eyes treated with anti-VEGF received the same agent throughout treatment and 7.7% were treated with both PRP and anti-VEGF agents. PRP rates declined from 784/1,000 treated eyes in 2012 to 566/1,000 in 2019 (pre-Protocol S: β = -32 vs. post-Protocol S: β = -77, p=0.005) while anti-VEGF rates increased from 876/1000 in 2012 to 1583/1000 in 2019 (β = -48 vs. β = 161, p=0.001). PRP rates in DME eyes did not significantly change from 474/1000 in 2012 to 363/1000 in 2019 (β = -9 vs. β = -58, p=0.091), but anti-VEGF rates increased significantly from 1533/1000 in 2012 to 2096/1000 in 2019 (β = -57 vs. β = 187, p=0.043). In eyes without DME, PRP use declined from 1017/1000 in 2012 to 707/1000 in 2019 (β = -31 vs. β = -111, p<0.001) and anti-VEGF use increased from 383/1000 in 2012 to 1226/1000 in 2019 (β = -48 vs. β = 140, p<0.001). CONCLUSIONS:Following the publication of Protocol S, PRP rates decreased while anti-VEGF rates increased largely from increases in bevacizumab use. PRP rates significantly declined among eyes without DME. Our findings indicate the impact that randomized controlled trials can have on real-world practice patterns.
PMID: 32693033
ISSN: 2468-7219
CID: 4533392

Epidemiology of United States Inpatient Open Globe Injuries from 2009-2015

Siddiqui, Neha; Chen, Evan M; Parikh, Ravi; Douglas, Vivian Paraskevi; Douglas, Konstantinos Aa; Feng, Paula W; Armstrong, Grayson W
PURPOSE/OBJECTIVE:To study the epidemiology of inpatient open globe injuries (OGI) in the United States (US). METHODS:This was a retrospective cohort study of patients with a primary diagnosis of OGI in the National Inpatient Sample (NIS) from 2009 to 2015. Sociodemographic characteristics, including age, gender, race, ethnicity, insurance, and income were stratified for comparison. Annual prevalence rates were calculated using 2010 US Census data. Statistical analysis included Chi-square tests, ANCOVA, and Tukey tests. RESULTS:< .05). CONCLUSIONS:Inpatient OGIs disproportionately affected those over 85, young males, elderly females, patients of African-American descent, on Medicare, and in the lowest income quartile. Additionally, children and young children had lower rates of OGI compared to adolescents. Further studies should delineate causes for socioeconomic differences in OGI rates to guide future public health measures.
PMID: 33522349
ISSN: 1744-5086
CID: 4793082

Reply to: RE: Relationship Between Choroidal Vascular Hyperpermeability, Choriocapillaris Flow Density, and Choroidal Thickness in Eyes with Pachychoroid Pigment Epitheliopathy

Sakurada, Yoichi; Fragiotta, Serena; Leong, Belinda Cs; Parikh, Ravi; Hussnain, S Amal; Freund, K Bailey
PMID: 33181763
ISSN: 1539-2864
CID: 4665502

Intravitreal Anti-Vascular Endothelial Growth Factor Cost Savings Achievable with Increased Bevacizumab Reimbursement and Utilization

Glasser, David B; Parikh, Ravi; Lum, Flora; Williams, George A
PURPOSE/OBJECTIVE:To model Medicare Part B and patient savings associated with increased bevacizumab payment and utilization for intravitreal anti-vascular endothelial growth factor (VEGF) therapy. DESIGN/METHODS:Cost analysis. METHODS:Medicare claims and IRIS® Registry data were used to calculate Medicare Part B expenditures and patient co-pays for anti-VEGF agents with increasing reimbursement and utilization of bevacizumab relative to ranibizumab and aflibercept. MAIN OUTCOME MEASURES/METHODS:Medicare Part B costs and patient co-pays for anti-VEGF agents in the Medicare fee-for-service (FFS) population. RESULTS:Increasing bevacizumab reimbursement to $125.78, equalizing the dollar margin with aflibercept, would result in Medicare Part B savings of $468 million and patient savings of $119 million with a 10% increase in bevacizumab market share. CONCLUSIONS:Increased utilization of bevacizumab achievable with increased reimbursement to eliminate the financial disincentive to its use would result in substantial savings to the Medicare Part B program and to patients receiving anti-VEGF intravitreal injections.
PMID: 32544559
ISSN: 1549-4713
CID: 4496722