Terry Gao, MD, a resident at Temple University Hospital, led a study that found that with potential implications for quality-of-care and access to services, Medicare reimbursement for most common breast cancer surgeries declined significantly over the last 20 years when adjusted for inflation. This study was presented at the American Society of Breast Surgeons Annual Meeting.

PHILADELPHIA (April 15, 2024) - With potential implications for quality-of-care and access to services, Medicare reimbursement for most common breast cancer surgeries declined significantly over the last 20 years when adjusted for inflation, according to a new study presented at the American Society of Breast Surgeons (ASBS) Annual Meeting.

The study, the first of its kind, examined reimbursements for 10 procedures, including breast biopsies, lumpectomies, mastectomies, and lymph node surgeries. The authors noted that Medicare pricing standards also are a major determinant of the reimbursements of most private insurance providers.

Stressing that reimbursements cover total procedure costs, Terry Gao, MD, a resident at Temple University Hospital and lead author on the study, said this includes not only the surgical fees but also overall facility staffing, operations, and hard goods.

"Inadequate funding strains healthcare resources, potentially affecting quality-of-care and possibly the financial viability of some hospitals, particularly safety net facilities serving the financially disadvantaged," added Gao, who conducted the study with researchers at Temple and Fox Chase.

Gao said physicians must lead the conversation about declining reimbursements because they experience the patient care impact firsthand. "This study is the first to put a number on the trend in declining breast cancer payments, which is an extremely significant loss. It is the initial step in understanding the full implications of this decline and working towards a solution to ensure quality patient care."

Researchers calculated the mean change during the entire 20-year period for the 10 procedures examined as +22.31%. However, during this time, the consumer price index rose 69%, suggesting a significant rise in inflation exceeding the mean increase in reimbursements for breast procedures.

In another analysis, after converting all 2003 reimbursements to 2023 dollars, the median reimbursement rate declined by 24.28%. Researchers also computed the compound annual growth rate (CAGR), a consistent percentage representing the average annual change during a specified time period, for these reimbursements in 2023 dollars as -1.54 per year.

While most procedures saw individual declines during this time period, after conversion into 2023 dollars, lumpectomy and simple mastectomy rose by 0.37% and 3.58% respectively. Their adjusted CAGRs also rose by 0.02% and 0.18% respectively.

However, Gao said the slightly positive increases do not represent meaningful gains. "The rate of inflation has been escalating over time. Our study found that these reimbursements are increasing at a much slower pace and likely will become negative numbers in several years."

Providing a more tangible perspective on reimbursements, researchers also examined in real dollars the decline in rates for certain frequently performed breast surgeries during the past 10 years. They grew 2013 compensation at the rate of inflation during that time period and subtracted from this the estimated 2023 reimbursements based on actual rates.

"With an incidence of 297,790 breast cancer patients as estimated by the American Cancer Society, we found that payments would be $111,488,311.65 less than if rates had kept pace with inflation from 2013 to 2023," Gao said.

"The decline in breast cancer surgery reimbursements is immense. This has serious consequences that policymakers, surgeons, and hospital administrators can't ignore. Unless addressed, we risk seeing a decline in crucial resources. … Hopefully, more studies like this will generate awareness and incentivize the healthcare system to work towards meaningful change."

The Study, "Evolving Economics: The Erosion of Medicare Reimbursement in Breast Surgery (2003-2023)," was presented at the ASBS Annual Meeting, which was held April 10-14 in Orlando, Florida.