Trends of Breast Reconstruction in Medicare Beneficiaries

Abstract

BACKGROUND: In April 2014, the Centers for Medicare and Medicaid Services released millions of billing records for over 880,000 healthcare providers in an effort to improve the transparency, accountability, and affordability of the US healthcare system. This study was performed to analyze the overall Medicare landscape with respect to surgeons, beneficiaries, services, and reimbursements in the setting of breast reconstruction. METHODS: This is a retrospective analysis of publicly available Medicare utilization and payment data for surgeons who provided services to Medicare beneficiaries between January 2012 and December 2017. Breast reconstruction Current Procedural Terminology (CPT) codes were queried using the Medicare Payment and Utilization Database. Statistical significance was computed using a one-way analysis of variance and Levene’s test was used to confirm the homogeneity of variances. RESULTS: Data included trends in the number of breast reconstructions over time and average Medicare reimbursements over time. In general, the number of breast reconstructions increased over the study period, with the greatest increase in free flap breast reconstruction (+55.5%) and the greatest decrease in TRAM reconstruction (−36.9%). On average, the Medicare payment amount per service was about 20% of the submitted charge. For example, reconstruction with latissimus flap charge in 2017 was $6,588 and payment amount was $1,358, resulting in a 79.4% reduction. Despite inflation and overall increases in healthcare costs, reimbursements in breast reconstruction have had little or no increase over time. The highest rate of change was Current Procedural Terminology 19366 (breast reconstruction with other technique), which increased from $957 in 2012 to $1,136 in 2017, for an +18% rate of change. Over the study interval, implant-based reconstruction increased around 12%, whereas latissimus and free flap reconstruction decreased around 2% over the same time interval. CONCLUSION: Our study identifies and quantifies wide variations in reimbursement for breast reconstruction procedures. Over the study period, reimbursement for implant-based reconstruction increased while autologous reconstruction decreased. Variations in reimbursement may preclude some surgeons from offering certain reconstructive options to a subset of patients. Addressing these potential care disparities in a growing patient population has major implications in quality of care for a large subset of women recovering from breast cancer. It is important for surgeons to understand these trends and to communicate with policy makers toward developing sustainable reimbursement models.