Breast cancer reimbursements see significant decline over the last 20 years

April 11, 2024
by Lisa Chamoff, Contributing Reporter
Medicare reimbursement for the most common breast cancer procedures declined by nearly 25% over the last two decades after adjusting for inflation, threatening quality of care, according to a study presented this week at the American Society of Breast Surgeons Annual Meeting in Orlando.

Researchers at Temple University Hospital and Fox Chase Cancer Center in Philadelphia used data from the Medicare Physician Fee Schedule Look-Up Tool to calculate the yearly Medicare reimbursement rate for 10 procedures — including breast biopsies, lumpectomies, mastectomies and lymph node surgeries — from 2003 to 2023. After figuring out the year-over-year change in rates for each procedure, they compared the overall median change to the Consumer Price Index.

Medicare reimbursement for the procedures, which usually determines what private insurers pay providers, increased 22.31% over 20 years not adjusting for inflation. At the same time, the Consumer Price Index increased by more than 69%. After adjusting for inflation, the researchers found that reimbursement rates for all procedures declined by a median of 24.28%.

The researchers also determined that payments were at least $111 million less than if reimbursement rates had kept pace with inflation from 2013 to 2023.

“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,” said Dr. Terry Gao, the lead author of the study and a resident at Temple University Hospital, in a statement announcing the results of the study. “Ultimately, this may lead to a drop in the availability and quality-of-care for breast cancer patients.”

Gao told HCB News that declining reimbursements make it harder for hospitals to invest in resources and programs that improve care, potentially worsening existing disparities. It could also create a shortage of surgeons, limiting patients’ access to specialists and continuing to strain staffing levels.

The study focused on identifying the trend of declining reimbursements, and Gao told HCB News that further research is needed to fully understand the reasons behind the decline.

“There might be a move toward rewarding efficiency and positive patient outcomes, potentially impacting traditional fee-for-service models, though importantly, there have been no studies to date that show declining reimbursements have led to increased efficiency,” she said.

Gao urged policymakers, surgeons and healthcare administrators to work together to “advocate for equitable policies that ensure continued access to high-quality breast cancer care, especially for vulnerable populations.”

In addition, Gao said providers should get involved with their specialty-specific organizations, such as the American Society of Breast Surgeons, and participate in the RUC reviewal process, which makes recommendations to the Centers for Medicare and Medicaid Services on annual updates to the Medicare relative value scale, determining how much providers are paid.