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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Thursday, April 18, 2024
As Medicare reimbursement rates decline, the quality of care given to patients with breast cancer may become compromised, according to Terry Gao, MD, of Temple University Hospital, Philadelphia. Dr. Gao and colleagues presented the findings of a recent study looking at data from breast cancer–related surgeries from the past 20 years during the 2024 American Society of Breast Surgeons (ASBrS) Annual Meeting.
“This study is the first to put a number on the trend in declining breast cancer payments, which is an extremely significant loss,” stated Dr. Gao in an ASBrS press release. It is the initial step in understanding the full implications of this decline and working toward a solution to ensure quality patient care.”
The study focused on data from 2003 to 2023 on 10 different breast operations, including biopsy, lumpectomy, and mastectomy, from the Medicare Physician Fee Schedule Look-Up Tool. The yearly Medicare reimbursement was then calculated, and the overall median change was compared with the Consumer Price Index from the U.S. Bureau of Labor Statistics.
When adjusted for inflation, the compound annual growth rate of breast operations overall steadily decreased 1.5% per year. The reimbursement rate had a median decline of 24.3%, with lumpectomy and simple mastectomy alone experiencing increases of more than 0.4% and 3.6%, respectively. “We estimate that breast surgeons will be reimbursed $111,469,311.65 less for these surgeries in 2023 than if rates had kept pace with inflation over the past 10 years,” said the study authors.
“Unless addressed, we risk seeing a decline in crucial resources,” Dr. Gao predicted. 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 breast cancer patients. Hopefully, more studies like this will generate awareness and incentivize the health-care system to work toward meaningful change.”
Disclosure: No disclosure information was provided.
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