Unnecessary treatments

Unlike the top biller in South Florida, some eyelid surgeons were willing to discuss their Medicare billing. “I’m disappointed that I am not number one. I wish I was on top,” joked John LiVecchi, a Florida plastic surgeon who was among the top 10 billers listed in 2008 Medicare data. LiVecchi, an eyelid specialist, said his practice at St. Luke’s Cataract and Laser Institute is one of the largest in the country, which accounts for his numbers. St. Luke’s operates five offices in the Tampa Bay area.

LiVecchi, who has had an eyelid lift himself, disputes that patients are flocking to the procedure primarily with vanity in mind. Patients with droopy eyelids often don’t realize how much the droopy skin is narrowing their field of vision, he said. LiVecchi said he jokes with his patients that he doesn’t want them driving in his neighborhood until after the surgery. “It’s safer for society,” he said.

As for the cosmetic boost, LiVecchi compared eyelid surgery to removing a cancerous lump from a patient’s face. In both cases the doctor’s primary objective is keep a patient healthy, he said. A more youthful appearance is only a pleasant side-effect, which he sees no problem with. “Doesn’t everybody want to look good?” he asked.

The benefits of functional eyelid surgery for some patients are documented. A 2011 study published in the journal Ophthalmology, for example, found that the surgery provided “significant improvement in vision, peripheral vision, and quality of life activities.”

Plastic surgeons interviewed said vision problems are not always the draw. Migliori, the president of the American Society of Ophthalmic Plastic and Reconstructive Surgery, said he sees three or four people a day who need the surgery at his practice at Rhode Island Hospital. But he conceded he faces a lot of pressure from patients who do not qualify. “They come in begging for you to do this surgery,” Migliori said. “You get a lot of pressure to bend the rules.”

Migliori said fudging the paperwork wouldn’t be hard. “You could tell the patient to squint,” he said, regarding the requirement that the condition be documented by a photograph, and then fake the vision test. But he thinks the majority of his colleagues are honest.

Surgeons make Medicare eyelid lifts big business

Medicare pays a third, or less, of what many surgeons charge patients out of pocket for cosmetic eye surgery. In the medical world, it is far from a big ticket item. But for practices with a large number of Medicare patients, the dollars quickly add up.

Sean Blaydon, an ophthalmic plastic surgeon at the Center for Aesthetic and Reconstructive Eyelid and Orbital Surgery in Austin, Texas, said his practice is a top biller of Medicare eyelid lifts because with five eyelid specialists, it is likely the largest center in the country. “Our bread and butter is eyelids,” Blaydon said.

Blaydon said the clinic’s high numbers make it vulnerable to Medicare appeals. The center keeps all patient records on site and hands them over to Medicare when they ask for them, he said.

Although Medicare contractors have strict rules for eyelid surgery, Blaydon said it’s hard to judge the reasons why patients are flocking to the surgery like never before. Some of it has to do with vision, he said. And some of it has to do with vanity.

“There is no questioning that when they come here they also want to look better,” Blaydon said.

The Center for Public Integrity is a non-profit, independent investigative news outlet. For more of its stories on this topic go to publicintegrity.org.