Over the past 20 years, Medicare reimbursements for 10 breast cancer surgical procedures rose by 22%, but inflation rose three times as much—by 69%. Compared with the financial picture had rates kept pace with inflation, the result is an estimated aggregate loss of more than $100 million for breast cancer surgeons, researchers reported at the 2024 American Society of Breast Surgeons Annual Meeting.1
The study findings were presented by Terry Gao, MD, a resident at Temple University Hospital, Philadelphia. Dr. Gao and colleagues from Temple and Fox Chase Cancer Center examined 10 procedures, including breast biopsy, lumpectomy, mastectomy, and axillary dissection, and their reimbursements between 2003 and 2023.
Terry Gao, MD
“Our analysis reveals a concerning discrepancy between rising inflation and the current Medicare reimbursement for breast cancer surgery, with a 21% decrease in inflation-adjusted Medicare compensation since 2023,” Dr. Gao commented. “This decline has the potential to jeopardize the financial sustainability of breast cancer surgery practices and access to essential care for Medicare beneficiaries,” she added.
Dr. Gao stressed that reimbursements cover total procedure costs, which includes not only surgical fees but also overall facility staffing, operations, and hard goods. “Inadequate funding strains health-care resources, potentially affecting the quality of care and possibly the financial viability of some hospitals, particularly safety net facilities serving the financially disadvantaged,” she said. Medicare pricing standards are a major determinant of the reimbursements of most private insurance providers, Dr. Gao noted.
Study Specifics
Based on adjusted data, the study found reimbursements increased from as little as 0.14% for sentinel node biopsy to 71.3% for simple mastectomy, with large variations observed among the different procedures. However, when the consumer price index (CPI) was considered, which increased over 20 years by 69.2%, the sentinel node biopsy reimbursement declined by 26%, and simple mastectomy reimbursement rose by 3.6%. Inflation-adjusted reimbursements for the 10 procedures averaged around 25% less over time, Dr. Gao reported during a press briefing.
Based on the American Cancer Society’s estimated incidence of 297,790 annual breast cancers, with 90% of those patients requiring some type of surgery, “the expected 2023 compensation” minus the “actual compensation” resulted in a “potential compensation loss of $107,605,444, Dr. Gao reported.
KEY POINTS
- Researchers from Temple University Hospital and Fox Chase Cancer Center evaluated Medicare reimbursements for 10 breast cancer surgical procedures over 20 years.
- Reimbursements rose by 22%, but inflation rose by 69%.
- Compared with the financial scenario, had rates kept pace with inflation, the aggregate loss is more than $100 million in reimbursements for breast cancer surgeries.
“The decline in breast cancer surgery reimbursements is immense,” she commented. “This has serious consequences that policymakers, surgeons, and hospital administrators cannot ignore. Unless they are addressed, we risk seeing a decline in crucial resources. This includes fewer hospital staff, a shortage of skilled surgeons, reduced funding for necessary equipment, and limited opportunities for caregiver training. Ultimately, this may lead to a drop in the availability and quality of care for patients with breast cancer. Hopefully, more studies like this will generate awareness and incentivize the health-care system to work toward meaningful change.”
Calculations
Annual Medicare reimbursement for each procedure was determined by multiplying procedure-specific relative value units by the overall conversion factor. Relative value units and conversion factors are determined annually by the Centers for Medicare & Medicaid Services. The researchers calculated the changes in reimbursement for each procedure and how they compared with the CPI, a well-established inflation metric that reflects the purchasing power of currency over time. Finally, the data were then adjusted for inflation.
Dr. Gao called for “a collaborative effort” to quantify the issue, raise awareness, determine the full impact of these trends, and advocate for an equitable solution “that will ensure continued access to high-quality breast cancer care.”
DISCLOSURE: Dr. Gao reported no conflicts of interest.
REFERENCE
EXPERT POINT OF VIEW
The study findings on Medicare reimbursement in breast cancer elicited a strong comment from Sarah Blair, MD, FACS, Professor and Vice Chair of Surgery at the University of California San Diego Health. “This study’s findings are deeply resonant for our community, as they affirm a long-standing concern: declining payments for crucial procedures performed by breast surgeons, especially when adjusted for inflation. They reflect the prevailing sentiment among many of us who have witnessed our salaries stagnate, failing to keep pace with the rising costs of living.”
Sarah Blair, MD, FACS
However, Dr. Blair emphasized, for most surgeons, “the decision to pursue breast surgery was driven not by financial motives but by a commitment to provide top-tier care in a highly intricate medical domain, particularly concerning such a prevalent illness as breast cancer.”
Dr. Blair continued: “Our profession demands relentless dedication to staying abreast of the latest research and advancements to ensure optimal patient outcomes. Through the diligent advocacy efforts of the American Society of Breast Surgeons, particularly via our legislative and coding committees, strides have been made to safeguard our remuneration from further erosion. This study’s data serve as valuable ammunition in our ongoing battle at the national level to secure fair compensation for the vital services we provide. It underscores the urgency of our collective efforts to address this pressing issue and to uphold the integrity of our profession.”
DISCLOSURE: Dr. Blair reported no conflicts of interest.
