WASHINGTON -- Aging Americans worried about their droopy upper eyelids often rely on the plastic surgeons scalpel to turn back the hands of time. Increasingly, Medicare is footing the bill.
The public health insurance program for people over 65 typically does not cover cosmetic surgery, but for cases in which a patients sagging eyelids significantly hinder their vision, it does pay to have them lifted. In recent years, though, a rapid rise in the number of so-called functional eyelid lifts, or blepharoplasty, has led some to question whether Medicare is letting procedures that are really cosmetic slip through the cracks at a cost of millions of dollars.
As the Obama administration and Congress wrestle over how to restrain Medicares growing price tag, critics say program administrators should be more closely inspecting rapidly proliferating procedures like blepharoplasty to make sure taxpayers are not getting ripped off.
From 2001 to 2011, eyelid lifts charged to Medicare more than tripled to 136,000 annually, according to a review of physician billing data by the Center for Public Integrity. In 2001, physicians billed taxpayers a total of $20 million for the procedure. By 2011, the price tag had quadrupled to $80 million. The number of physicians billing the surgery more than doubled.
With this kind of management malpractice, its little wonder that the (Medicare) program is in such dire shape, said Sen. Tom Coburn, R-Okla., who is a physician. The federal government is essentially asking people to game the system.
Plastic surgeons say there are a number of legitimate reasons for the spike, including a tendency among the elderly to seek fixes for real medical issues they might have quietly suffered through even a decade ago. But surgeons also acknowledge an increased awareness of the surgery fueled by reality television, word-of-mouth referrals and advertising that promises a more youthful appearance. And doctors concede they face increased pressure from patients to perform eyelid lifts, even when they do not meet Medicares requirement that peripheral vision actually be impaired.
Thomas Scully, a former Medicare administrator under President George W. Bush, has a blunter assessment: He doubts the jump is caused by anything other than seniors seeking younger-looking eyes. How many seniors among your friends or family have needed eyelid surgery? he said. I bet a hell of a lot of them at 65 say, You know what, I bet I can get Medicare to pay for this. And I can imagine the plastic surgeons love it. If you can go to patients and say that Medicare will pay, they will do it in much larger numbers.
Strict Medicare guidelines difficult to enforce
Quick, easy and relatively painless, eyelid surgery is one of the most popular cosmetic procedures, with patients paying out of pocket for more than 200,000 a year, according to the American Society of Plastic Surgeons. The process for purely cosmetic surgeries and Medicare-funded blepharoplasty is the same. Doctors numb the eyelids with a local anesthetic before removing fat and excess skin, often with a laser. The entire process usually takes less than 30 minutes.
Medicare reimbursement ranges from $574 to $640 per eye, depending on the setting, but the rules for Medicare coverage are firm. Purely cosmetic surgeries do not qualify. Before filing a Medicare claim, doctors are required to test a patients vision and document that drooping skin significantly compromises a patients eyesight. The exam usually involves lifting a patients eyelids with tape and comparing their vision results to tests performed without tape.