Women may be hurt by low Medicare payments
The recent increases in Medicare payment standards for two minimally invasive procedures that benefit women needle breast biopsies and outpatient endometrial resection and ablations (OPERA) will not help end inequities affecting many women patients, say women’s health care advocates who want the rates raised even higher.
The reimbursement rate for OPERA, which is used to treat abnormal uterine bleeding as an alternative to a hysterectomy, was raised in February. Medicare rates for needle biopsy were raised last year.
While higher, these new Medicare rates still fall far short of reimbursement for older, more invasive procedures and still inhibit women’s access to new, less invasive medical techniques that lead to quicker recoveries, argues Wade Aubry, MD, associate clinical professor of medicine at the Institute for Health Policy Studies at the University of California at San Francisco.
"It’s time for Medicare to recognize the value of the new, less invasive alternatives and reimburse at a similar rate as for older procedures that accomplish the same result," says Aubry. "Only then can women be assured of access to a full range of appropriate options for breast cancer diagnosis and for treatment of abnormal uterine bleeding."
Shorter, cheaper, less invasive
OPERA involves the removal of the lining of the uterus and any uterine fibroids within the uterus. For many women who have abnormal uterine bleeding, the procedure is a safe, cost-effective alternative to hysterectomy, according to Aubry.
The OPERA technology has been cleared by the FDA and is employed in a shorter and less invasive procedure that spares vital organs. OPERA can significantly reduce overall costs and does not entail the long recovery, complications, and side effects that often accompany hysterectomy, Aubry says.
Various forms of needle breast biopsies have been demonstrated to be accurate alternatives to open surgical breast biopsy, Aubry says. They allow a woman to have an outpatient breast biopsy without the potential for significant pain and breast disfigurement that can accompany open surgical biopsy in an operating room.
A surgeon who performs a needle biopsy is paid an average of either $84 or $242, depending upon which code is used under Medicare standards for doing the procedure, Aubry says. The same surgeon would be paid $363 for an open excisional biopsy, so reimbursement for the open surgery is at least 50% greater.
"Because surgeons are better compensated for doing an open biopsy, some of them have been slow to offer women the less invasive procedures, even though these newer kinds of biopsies are very accurate and don’t have the drawbacks of open surgical biopsy," says Mary Beth Tomaselli, MD, a Coral Springs, FL, breast surgeon.
"It’s the law of unintended consequences," says Peter Cherouny, MD, associate professor of department of obstetrics and gynecology at the University of Vermont.
"You alter reimbursement, and then there may be less of an incentive for a physician to go out and learn a new technique if he or she feels that he or she is getting less reimbursement for it."
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