Stalled at the intersection: insurance status and disparities in post-mastectomy breast reconstruction

Friedman-Eldar, Orli; Burke, Jonathan; Silva, Iago De Castro; Baumrucker, Camille; Valle, Fernando; Lessard, Anne-Sophie; Kassira, Wrood; Franceschi, Dido; Kesmodel, Susan B.; Avisar, Eli; Goel, Neha; Möller, Mecker G.

doi:10.1007/s10549-022-06639-8

Cited by 9 publications

(10 citation statements)

References 33 publications

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“…diagnosis, delays in treatment, and lower odds of undergoing PMBR. 5,19 While this association is likely multifactorial, financial burden secondary to excessive markups is a potential barrier to accessing appropriate care for disadvantaged patients. 20 Medicare data have been widely used to study hospital and procedural markups in previous studies.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020

Gong,

Koh,

Sobti

et al. 2023

J Reconstr Microsurg

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Background: With greater acceptance of post-mastectomy breast reconstruction (PMBR) as a safe and reliable treatment option, the role of plastic surgeons in breast cancer management continues to rise. As Medicare reimbursements for surgical procedures decline, hospitals may increase charges. Excessive markups can negatively affect uninsured and underinsured patients. We aimed to analyze mastectomy and breast reconstruction procedures to gain insights into recent trends in utilization and billing. Methods: We queried the 2013-2020 Medicare Provider Utilization and Payment Data with 14 Current Procedural Terminology (CPT) codes to collect service counts, hospital charges, and reimbursements. We calculated utilization (service counts per million female Medicare enrollees), weighted mean charges and reimbursements, and charge-to-reimbursement ratios (CRRs). We calculated total and annual % changes for the included CPT codes. Results: Among the 14 CPT codes, 12 CPT codes (85.7%) with non-zero service counts were included. Utilization of mastectomy and breast reconstruction procedures decreased from 1,889 to 1,288 (-31.8%) procedures per million female Medicare beneficiaries from 2013 to 2020. While the utilization of immediate implant placements (CPT 19340) increased by 36.2%, the utilization of delayed implant placements (CPT 19342) decreased by 15.1%. Reimbursements for the included CPT codes changed minimally over time (-2.9%), but charges increased by 28.9%. These changes resulted in CRRs increasing from 3.3 to 4.4 (+33.3%) from 2013 to 2020. Free flap reconstructions (CPT 19364) had the highest CRRs throughout the study period, increasing from 7.0 in 2013 to 10.3 in 2020 (+47.1%). Conclusions: Our analysis of mastectomy and breast reconstruction procedures billed to Medicare Part B from 2013 to 2020 showed increasingly excessive procedural charges. Rises in hospital charges and CRRs may limit uninsured and underinsured patients from accessing necessary care for breast cancer management. Legislations that monitor hospital markups for post-mastectomy breast reconstruction procedures may be considered by policymakers.

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Section: Accepted Manuscriptmentioning

confidence: 99%

“…4 Despite such efforts, utilization of PMBR remains lower than expected, especially among uninsured patients. 5 Annually, the Centers for Medicare and Medicaid Services (CMS) assigns reimbursement rates for procedures in a fee-for-service manner. 6 Each procedure is billed with a corresponding Current Procedural Terminology (CPT) code.…”

Section: Introductionmentioning

confidence: 99%

Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020

Gong,

Koh,

Sobti

et al. 2023

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…4 Despite such efforts, utilization of PMBR remains lower than expected, especially among uninsured patients. 5 Annually, the Centers for Medicare and Medicaid Services (CMS) assigns reimbursement rates for procedures in a feefor-service manner. 6 Each procedure is billed with a corresponding Current Procedural Terminology (CPT) code.…”

mentioning

confidence: 99%

“…18 Compared to private insurance, uninsured status was associated with late-stage breast cancer diagnosis, delays in treatment, and lower odds of undergoing PMBR. 5,19 While this association is likely multifactorial, financial burden secondary to excessive markups is a potential barrier to accessing appropriate care for disadvantaged patients. 20 Medicare data have been widely used to study hospital and procedural markups in previous studies.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020

Gong,

Koh,

Sobti

et al. 2023

J Reconstr Microsurg

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Background: There has been a greater focus in recent literature proposing air to be a superior medium to saline in tissue expanders. This study aims to review the literature and assess the quality of data on the efficacy and safety of air as an alternative medium to saline in tissue expanders, in the setting of post-mastectomy two-stage reconstruction. Methods: A systematic review regarding air inflation of tissue expanders were conducted using PubMed, Embase, Cochrane Library, and Web of Science. The methods followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three reviewers separately performed data extraction and comprehensive synthesis. Results: A total of 427 articles were identified in our search query, of which 12 met the inclusion criteria. Thee pertained to inflation with room air, and eight pertained to inflation with CO2 using the AeroForm device. There were comparable to decreased overall complication rates in the room air/CO2 cohort compared to saline, although statistical significance was only observed in one of five two-arm studies. Investigating specific complications in the five two-arm studies, significantly lower rates of skin flap necrosis were only observed in two CO2-based studies. Studies rarely discussed other safety profile concerns, such as the impacts of air travel, radiation planning, and air extravasation beyond descriptions of select patients within the cohort. Conclusion: There is insufficient evidence to suggest improved outcomes with room air inflation of tissue expanders. Further work is needed to fully characterize the benefits and safety profiles of air insufflation before being adopted into clinical practice.

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Financial Toxicity Considerations in Breast Reconstruction: Recommendations for Research and Practice

Kinzer,

Lee,

Cooksey

et al. 2024

Women's Health Issues

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Stalled at the intersection: insurance status and disparities in post-mastectomy breast reconstruction

Cited by 9 publications

References 33 publications

Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020

Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020

Trends in Hospital Billing for Mastectomy and Breast Reconstruction Procedures from 2013 to 2020

Financial Toxicity Considerations in Breast Reconstruction: Recommendations for Research and Practice

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