Lucci Anthony, Shoher Angela, Sherman Marc O, Azzizadeh Ali
Michael E. DeBakey Department of Surgery and the Breast Care Center at Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA.
Ann Surg Oncol. 2004 Dec;11(12):1037-44. doi: 10.1245/ASO.2004.03.034. Epub 2004 Nov 15.
Medicare determines procedural reimbursement by means of formulas considering physician work, practice, and liability expenses. Since no mechanism exists to consider outcomes in calculating reimbursements, we hypothesized that Medicare reimbursements do not correlate with outcomes for different breast cancer operations.
We prospectively studied 240 patients with T1, 2N0M0 breast cancer in three surgical treatment arms: segmental mastectomy with axillary node dissection (SM&ALND ; n = 42); SM with sentinel node dissection (SM&SLND ; n = 96); and mastectomy without reconstruction (MRM; n = 102). Outcome parameters of complications, hospital stay, analgesic usage, and days to return to work were correlated with procedure reimbursements.
Median follow-up was 26 months. SM&SLND patients rarely required hospital stays (14%) in comparison with either SM&ALND (96%) or MRM patients (99%) (P < 0.001). SM&ALND and MRM patients required 9 and 10 median days of narcotics, respectively, versus 1 day in the SLND group (P < 0.001). SM&SLND patients returned to work at a median of 3 days, in comparison with 19 for SM&ALND and 26 for MRM patients (P < 0.001). Complications were more common in the MRM group (67% numbness/10% pain) and the SM&ALND group (56%/9%) than in the SM&SLND group (0%/1%). Reimbursements were inversely correlated with outcomes. MRM was reimbursed the highest, at an average of 1,075.03 dollars, with SM&ALND at 882.72 dollars. SM&SLND was reimbursed at 642.00 dollars.
Medicare reimbursements for breast cancer operations do not correlate with outcomes. Less-invasive procedures are paid for at lower rates despite better outcomes and fewer complications. The data from this study raise the question of the impact of reimbursement on breast procedure selection.
医疗保险通过考虑医生工作、执业及责任费用的公式来确定手术报销额度。由于在计算报销额度时不存在考虑治疗结果的机制，我们推测医疗保险报销额度与不同乳腺癌手术的治疗结果无关。
我们前瞻性地研究了240例T1、2N0M0期乳腺癌患者，分为三个手术治疗组：保乳手术加腋窝淋巴结清扫术（SM&ALND；n = 42）；保乳手术加前哨淋巴结活检术（SM&SLND；n = 96）；以及单纯乳房切除术（MRM；n = 102）。将并发症、住院时间、镇痛药物使用情况及恢复工作天数等治疗结果参数与手术报销额度进行关联分析。
中位随访时间为26个月。与SM&ALND组（96%）或MRM组（99%）相比，SM&SLND组患者很少需要住院（14%）（P < 0.001）。SM&ALND组和MRM组患者分别需要中位9天和10天的麻醉镇痛药，而前哨淋巴结活检组仅需1天（P < 0.001）。SM&SLND组患者中位3天恢复工作，而SM&ALND组为19天，MRM组为26天（P < 0.001）。MRM组（67%麻木/10%疼痛）和SM&ALND组（56%/9%）的并发症比SM&SLND组（0%/1%）更常见。报销额度与治疗结果呈负相关。MRM组报销额度最高，平均为1,075.03美元，SM&ALND组为882.72美元。SM&SLND组报销额度为642.00美元。
医疗保险对乳腺癌手术的报销额度与治疗结果无关。尽管微创术式治疗效果更好、并发症更少，但报销费率更低。本研究数据引发了关于报销额度对乳腺癌手术术式选择影响的问题。
