Cancer surgery reimbursements experience ‘immense’ decline over last 2 decades
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Key takeaways:
- Researchers estimate Medicare reimbursements will be over $100M less in 2023 than if rates had kept up with inflation.
- The inflation-adjusted median reimbursement rate declined by nearly one-quarter.
The Medicare reimbursement rate for 10 common breast cancer-related surgical operations failed to outpace inflation over the last 20 years, according to a presentation at American Society of Breast Surgeons Annual Meeting.
Adjusted for inflation, the median reimbursement rate for the group of procedures decreased by more than 24% during the study period.
Through an analysis of the real-life impact of declining Medicare reimbursement rates over the past 20 years, researchers estimated that breast surgeons will be reimbursed approximately $110,000,000 less for such surgeries in 2023 than if reimbursement rates had kept up with inflation over the past decade.
“Our analysis reveals a concerning discrepancy between rising inflation and current Medicare reimbursement for breast cancer surgery, with a 21% decrease in inflation-adjusted Medicare compensation since 2023,” Terry P. Gao, MD, resident at Temple University Hospital, said during a presentation.
“This decline has the potential to jeopardize the financial sustainability of breast cancer surgery practices as well as access to essential care for Medicare beneficiaries,” she added.
“To address this, we need a collaborative effort, which first begins with quantifying the issue and raising awareness. By working together to understand the full impact of these trends, we can advocate for equitable solutions that help ensure continued access to high-quality breast cancer care.”
Background, methods
As a primary determinant of reimbursement rates for medical services, Medicare can establish the pricing standard for private insurance policies. Numerous medical specialties have experienced decreasing Medicare reimbursement rates in recent years, but the trend has not yet been studied in breast surgery, according to researchers.
Gao and colleagues conducted a study to investigate Medicare reimbursement rates for breast surgery operations using data on 10 breast cancer-related procedures, obtained through the Medicare Physician Fee Schedule Look-Up Tool.
The study examined a range of breast cancer-related surgeries for the 20-year period from 2003 to 2023 — including breast biopsies, lumpectomies, mastectomies and lymph node removals — while also incorporating data extraction for sentinel lymph node biopsy injection in 2011, when the CPT code came into effect.
CMS annually calculates each respective operation’s relative value units (RVU) and a conversion factor (CF). Researchers calculated yearly Medicare reimbursement by multiplying each operation’s respective RVU by the CF, with a year-to-year percentage change being calculated for Medicare reimbursement for each operation.
Study investigators then compared the overall median change to changes in the Consumer Price Index from the U.S. Bureau of Labor Statistics to assess a potential relationship between Medicare compensation and inflation, with all data then being adjusted for inflation in 2023 U.S. dollars.
Using projected 2023 breast cancer incidence, researchers used the findings to estimate the real-world deficit in reimbursement rates.
Results, next steps
Researchers determined the median unadjusted percent change for the 10 breast operations to be 22.31% (interquartile range, 6.69% to 26.95%) during the study period; over that same time span, the Consumer Price Index increased by 69.15% (P < .001).
After adjusting for inflation, researchers reported that the reimbursement rate for all operations experienced a median decline of 24.28% (IQR, 25.81% to 23.11%).
Between 2003 and 2023, researchers observed increases in inflation-adjusted Medicare reimbursement for lumpectomy (0.37%) and simple mastectomy (3.58%), whereas the adjusted reimbursement rates for all 10 operations showed a negative median annual growth rate of 1.54%, thus highlighting a year-to-year decline in reimbursement rate after adjusting for inflation.
Researchers used the data to create a hypothetical scenario to demonstrate the real-world impact of declining Medicare reimbursements. With an estimated case volume of 297,790 for 2023 for breast cancer case incidence, they estimated that if 10% of patients had stage IV lung cancer with 90% of patients undergoing surgical treatment (80% auxiliary surgery, 50% breast lumpectomy, 50% simple mastectomy), that over $110,000,000 less will have been reimbursed than if rates had kept up with inflation.
Gao said studies like this can help raise awareness to the problem while also highlighting specific areas that are being most heavily impacted financially, thus allowing policy makers to implement solutions before even more drastic changes are made to medical services.
“The decline in breast cancer surgery reimbursements is immense,” Gao said in a press release. “This has serious consequences that policymakers, surgeons and hospital administrators can't ignore. Unless 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],” she added. “Hopefully, more studies like this will generate awareness and incentivize the health care system to work towards meaningful change.”
References:
• Breast cancer surgical reimbursements decline significantly from 2003-2023 (press release). Available at: https://www.breastsurgeons.org/. Published April 11, 2024. Accessed April 17, 2024.
• Gao TP, et al. Evolving economics: the erosion of Medicare reimbursement in breast surgery (2003-2023). Presented at: The American Society of Breast Surgeons Annual Meeting press briefing; April 3, 2024.
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Gao TP, et al. Presented at: American Society of Breast Surgeons Annual Meeting press briefing; April 3, 2024.
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