D107. Head and Neck Cancer Reconstruction and Relative Disincentives to Surgical Reconstruction

Abstract

PURPOSE: The incidence of head and neck cancers (HNC) is rising as HPV becomes the dominant disease etiologic factor. Financial support for HNC care is critical for ensuring equitable access to care. Examining non-profit support, reimbursement rates and hospital-associated costs for HNC patients relative to other patients requiring complex reconstruction may reveal possible care disparities. METHODS: Reimbursement data from HNC and breast cancer (BC) reconstructive procedures was abstracted from the Centers for Medicare and Medicaid Services Physician Fee Schedule Look-Up Tool. Patient-level data for 2015 to 2017 was acquired from the New York State Department of Health. Inflation-adjusted reimbursement values from 2012 to 2021 were compared using Student’s t-test. Wilcoxon-Mann-Whitney tests were used for inter-group analyses. Analysis was completed in R Studio (v1. 3.1). RESULTS: Procedure reimbursements for free and pedicled flaps indicate that HNC reconstruction procedures are reimbursed significantly lower than both breast and extremity reconstruction (p < 0.01). New York State inpatient data indicates that HNC procedure recipients are more likely to have public insurance, generate higher hospital costs and require longer lengths of stay than patients hospitalized for BC procedures (p < 0.01). CONCLUSION: Reimbursements for HNC reconstructive procedures are significantly lower than BC and extremity reconstructive procedures of comparable work effort. HNC patients are more likely to be publicly insured and have longer lengths of stay than patients undergoing breast reconstruction. The large discrepancy in reimbursement may financially disincentivize investment in care for HNC patients and limit future access to care in this vulnerable and growing patient population.