TY - JOUR
T1 - A Cross-Sectional Study of Variations in Reimbursement for Breast Reconstruction
T2 - Is A Healthcare Disparity On the Horizon?
AU - Odom, Elizabeth B.
AU - Schmidt, Alexandra C.
AU - Myckatyn, Terence M.
AU - Buck, Donald W.
N1 - Funding Information:
Received May 15, 2017, and accepted for publication, after revision July 30, 2017. From the Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St Louis, MO. Conflicts of interest and sources of funding: This research was supported by T32CA190194 (Principle Investigator: Colditz, funding for Elizabeth Odom) and by the Foundation for Barnes-Jewish Hospital and by Siteman Cancer Center. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health. The authors have no other financial disclosures. Reprints: Donald W. Buck, MD, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 S Euclid Ave, NW Tower, 1150, Box 3283, St Louis, MO 63110. E-mail: dwbuck@wustl.edu. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0148-7043/18/8003–0282 DOI: 10.1097/SAP.0000000000001228
Publisher Copyright:
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Background: Despite growing demand for breast reconstruction, financial disincentives to perform breast reconstruction in patients with government-sponsored insurance plans may lead to longer wait times and decreased access to care. We identify the variation in reimbursement for implant and autologous reconstruction as a step toward understanding these financial implications, to develop safeguards to minimize effects on access to care. Methods: Billing data were collected over a 10-year period for patients undergoing implant-based (19357) or free-flap (19364) breast reconstruction. Patients were placed into cohorts according to insurance type - Medicare, Medicaid, or private insurance, and these were directly compared. Results: A total of 2691 women underwent breast reconstruction between 2003 and 2013; 71.2% had private insurance, 13.3% had Medicaid, and 14.49% had Medicare. For implant-based reconstructions, the average reimbursement of total charges was 16.3% for Medicaid, 28.3% for Medicare, and 67.2% for private insurance. For autologous reconstruction, average reimbursement was 12.37% for Medicaid, 22.9% for Medicare, and 35.35% for private insurance. Hourly reimbursement estimates for Medicaid patients undergoing autologous reconstruction were lowest. The highest hourly reimbursement estimate was for privately insured patients undergoing implant-based reconstruction. Over time, reimbursement for autologous reconstruction has declined significantly for all payor types, whereas implant-based reimbursement disparities are narrowing. Conclusions: We found that wide variations in reimbursement for breast reconstruction procedures exist and may preclude some surgeons from offering certain reconstructive options to a subset of patients. Understanding these discrepancies is a key first step in minimizing a potential care delivery disparity for this patient population.
AB - Background: Despite growing demand for breast reconstruction, financial disincentives to perform breast reconstruction in patients with government-sponsored insurance plans may lead to longer wait times and decreased access to care. We identify the variation in reimbursement for implant and autologous reconstruction as a step toward understanding these financial implications, to develop safeguards to minimize effects on access to care. Methods: Billing data were collected over a 10-year period for patients undergoing implant-based (19357) or free-flap (19364) breast reconstruction. Patients were placed into cohorts according to insurance type - Medicare, Medicaid, or private insurance, and these were directly compared. Results: A total of 2691 women underwent breast reconstruction between 2003 and 2013; 71.2% had private insurance, 13.3% had Medicaid, and 14.49% had Medicare. For implant-based reconstructions, the average reimbursement of total charges was 16.3% for Medicaid, 28.3% for Medicare, and 67.2% for private insurance. For autologous reconstruction, average reimbursement was 12.37% for Medicaid, 22.9% for Medicare, and 35.35% for private insurance. Hourly reimbursement estimates for Medicaid patients undergoing autologous reconstruction were lowest. The highest hourly reimbursement estimate was for privately insured patients undergoing implant-based reconstruction. Over time, reimbursement for autologous reconstruction has declined significantly for all payor types, whereas implant-based reimbursement disparities are narrowing. Conclusions: We found that wide variations in reimbursement for breast reconstruction procedures exist and may preclude some surgeons from offering certain reconstructive options to a subset of patients. Understanding these discrepancies is a key first step in minimizing a potential care delivery disparity for this patient population.
KW - breast reconstruction
KW - healthcare disparities
KW - reimbursement
UR - http://www.scopus.com/inward/record.url?scp=85042384236&partnerID=8YFLogxK
U2 - 10.1097/SAP.0000000000001228
DO - 10.1097/SAP.0000000000001228
M3 - Article
C2 - 28984659
AN - SCOPUS:85042384236
VL - 80
SP - 282
EP - 286
JO - Annals of Plastic Surgery
JF - Annals of Plastic Surgery
SN - 0148-7043
IS - 3
ER -