Routine preoperative medical testing is no longer the standard practice for patients undergoing cataract surgery (the cost associated is 2.55× higher compared to selective medical testing).1, 2 However, history and physicals are required by the Centers for Medicare and Medicaid Services for all patients within 30 days of surgery. This case series found that phone visits in lieu of standard H&Ps in patients scheduled for cataract surgery were not associated with increased unplanned admissions, mortality, or surgery cancellations. It helped streamline appointments and allowed providers to focus on more complex patients undergoing surgery with general anesthesia. Noncompliance with preoperative assessments and same day surgery cancellations were significantly lower for phone visits. The reason for reduced cancellations is unclear, but it may be due to an increased presence of comorbidities in those undergoing standard H&Ps, leading to higher number of cancellations for medical reasons.
Publication by Schein et al. argues that cataract surgery is “remarkably safe” and there is no evidence that a required history and physical adds benefit beyond the screening performed on the day of surgery by the surgeon and anesthesiologist.3 Jastrzebski et al. also advocates a graded approach to preoperative assessments.4 Based on our results, we believe the universal application of independent and complete in-person H&Ps for patients undergoing cataract surgery is not medically necessary for most patients, represents low-value care, and increases visit burden. At BMC phone visits are now standard for all eye surgery, including non-cataract eye procedures, and is considering expansion of phone visits to other non-ocular procedures that are similarly short in duration requiring monitored IV sedation.