The Effect of the Breast Cancer Provider Discussion Law on Breast Reconstruction Rates in New York State

Abstract

Background: New York State passed the Breast Cancer Provider Discussion Law in 2010, mandating discussion of insurance coverage for reconstruction and expedient plastic surgical referral, two significant factors found to affect reconstruction rates. This study examines the impact of this law. Methods: A retrospective cohort study of the New York State Planning and Research Cooperative System database to examine breast reconstruction rates 3 years before and 3 years after law enactment was performed. Difference-interrupted time series models were used to compare trends in the reconstruction rates by sociodemographic factors and provider types. Results: The study included 32,452 patients. The number of mastectomies decreased from 6479 in 2008 to 5235 in 2013; the rate of reconstruction increased from 49 percent in 2008 to 62 percent in 2013. This rise was seen across all median income brackets, races, and age groups. When comparing before to after law enactment, the increase in risk-adjusted reconstruction rates was significantly higher for African Americans and elderly patients, but the disparity in reconstruction rates did not change for other races, different income levels, or insurance types. Reconstruction rates were also not significantly different between those treated in various hospital settings. Conclusions: The aim of the Breast Cancer Provider Discussion Law is to improve reconstruction rates through provider-driven patient education. The authors’ data show significant change following law passage in African American and elderly populations, suggesting effectiveness of the law. The New York State Provider Discussion Law may provide a template for other states to model legislation geared toward patient-centered improvement of health outcomes.

Persistent Disparities in Postmastectomy Breast Reconstruction and Strategies for Mitigation

“…Reconstruction rates increased significantly for AA women after implementation of the law, demonstrating the effectiveness of provider-driven patient education. 29 With previous studies describing differences in referral for surgery, geographical access to reconstructive surgeons also has been explored in the literature. In 2017, Bauder et al compared inpatient and ambulatory surgery data from ten states and demonstrated that higher plastic surgeon density was positively correlated with breast reconstruction rates.…”

Community collaboration to improve access and outcomes in breast cancer reconstruction: protocol for a mixed-methods qualitative research study

“…In patients who elect to undergo breast reconstruction, the improvement in quality of life for many is substantial 5–7. As access to reconstructive breast care has increased in the USA, the rate of breast reconstruction following mastectomy has dramatically increased over the past 20 years 8 9. However, despite increasing overall rates of reconstruction, rates of breast reconstruction vary in different patient populations and due to different institutional structures 10 11.…”

Patient‐provider discussions of bariatric surgery and subsequent weight changes and receipt of bariatric surgery

“…Research suggests that patient‐provider discussions have a significant impact on patient decisions to undergo procedures (1,2). Therefore, counseling the patient about bariatric surgery as a treatment option in outpatient settings is expected to be a crucial step in a patient’s decision to undergo the procedure (3,4), and survey studies have found that patients are more likely to undergo bariatric surgery when it is recommended by their health care provider (5).…”