Trends of Medicare Reimbursement for Breast Cancer and Reconstructive Surgery

Abstract

Abstract Introduction Prior studies have shown a decrease in Medicare reimbursements in some surgical disciplines; however, it is unclear as to how the reimbursement of breast cancer surgeons and the hospitals they operate in have been affected by changes in the healthcare economy over time. This study evaluated trends in Medicare reimbursement for breast oncologic and reconstructive surgery. Methods We identified the CPT codes representing a wide variety of breast oncologic and reconstructive procedures performed at our institution from 2010–2021. These CPT codes were used to identify relevant information within the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid. Average national relative value units (RVUs) for physician-based work, facilities, and malpractice were collected along with the corresponding conversion factors for each year. Consumer price index and general inflation for each year were used to adjust values. Results From 2010 to 2021, there was an overall average decrease of 14.76% in Medicare reimbursement for both breast oncology (-11.41%) and reconstructive procedures (-16.38%). During this period there was an adjusted compound annual growth rate (CAGR) of -1.49, indicating an average annual decrease in reimbursement for the selected procedures. Meanwhile, there was a 2.34% increase of physician-based work RVUs, an 8.01% increase of facility-based RVUs, and a 33.11% increase of malpractice-based RVUs on average per procedure. Conclusion Over the past decade, Medicare reimbursement rates for breast surgeries have decreased. Based on these findings, breast and reconstructive surgeons should advocate for reimbursement that better reflects the costs of their practice.