Charalampos Siotos

Summary: No clear evidence‐based consensus has been reached on taxanes and the development of lymphedema. The cumulative effect of longer duration chemotherapy needs to be accounted for in analyses. Larger and more balanced study designs are needed to capture the risks of lymphedema from taxanes.

Background: While nearly 1 in 5 Americans receives health insurance coverage through Medicare, literature suggests that Medicare reimbursement is lagging behind inflation for many plastic surgery procedures. Aim: This article evaluates trends in Medicare reimbursement for gender affirmation procedures. Methods: The most common gender affirmation procedures performed at an urban academic medical center were identified in this cross-sectional study (level 4 evidence). Five nongender surgery codes were evaluated for reference. A standardized formula utilizing relative value units (RVUs) was used to calculate monetary data. Differences in reimbursement between 2014 and 2021 were calculated for each procedure. Outcome: The main outcome was inflation-adjusted difference of charges from 2014 to 2021. Results: Between 2014 and 2021, Medicare reimbursement for gender affirmation procedures had an inflation-unadjusted average change of –0.09% (vs +5.63% for the selected nongender codes) and an inflation-adjusted change of –10.03% (vs –5.54% for the selected nongender codes). Trends in reimbursement varied by category of gender-affirming procedure. The overall average compound annual growth rate had a change of –0.99% (vs –0.53% for the selected nongender codes). The average changes in work, facility, and malpractice RVUs were –1.05%, +9.52%, and –0.93%, respectively. Clinical Implications: Gender surgeons and patients should be aware that the decrease in reimbursement may affect access to gender-affirming care. Strengths and Limitations: Our study is one of the first evaluating the reimbursement rates associated with the full spectrum of gender affirmation surgery. However, our study is limited by its cross-sectional nature. Conclusions: From 2014 to 2021, Medicare reimbursement for gender affirmation procedures lagged inflation.

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.

Background Data collected across many surgical specialties suggest that Medicare reimbursement for physicians consistently lags inflation. Studies are needed that describe reimbursement rates for lower extremity procedures. Our goal is to analyze the trends in Medicare reimbursement rates from 2010 to 2021 for both lower extremity amputation and salvage surgeries. Methods The Physician Fee Schedule Look-Up Tool of the Centers for Medicare and Medicaid Services was assessed and Current Procedural Terminology codes for common lower extremity procedures were collected. Average reimbursement rates from 2010 to 2021 were analyzed and adjusted for inflation. The rates of work-, facility-, and malpractice-related relative value units (RVUs) were also collected. Results We found an overall increase in Medicare reimbursement of 4.73% over the study period for lower extremity surgery. However, after adjusting for inflation, the average reimbursement decreased by 13.19%. The adjusted relative difference was calculated to be (−)18.31 and (−)11.34% for lower extremity amputation and salvage procedures, respectively. We also found that physician work-related RVUs decreased by 0.27%, while facility-related and malpractice-related RVUs increased. Conclusion Reimbursement for lower extremity amputation and salvage procedures has steadily declined from 2010 to 2021 after adjusting for inflation, with amputation procedures being devaluated at a greater rate than lower extremity salvage procedures. With the recent marked inflation, knowledge of these trends is crucial for surgeons, hospitals, and health care policymakers to ensure appropriate physician reimbursement. Level of Evidence IV (cross-sectional study).

Background The impact of the COVID-19 pandemic on physician relationships with industry and subsequent financial implications has not been previously assessed. The aim of this study is to compare pre- and post-COVID-19 payments between industry and medical providers for all plastic surgeons. Methods Payment information was collected for the 2019 and 2020 reporting periods from the Open Payments Program (OPP) database for plastic surgeons and plastic surgeon subspecialists. An analysis was performed of trends and comparison of payments for each year for all plastic surgeons and each subspecialty cohort. Results For all plastic surgeons, there was a decrease in industry payments between 2019 and 2020 (− 30.5%). All plastic surgery subspecialties had a decrease in payments with general plastic and reconstructive surgery affected the most (− 56%) and craniofacial surgery affected the least (− 9%). Payments for almost all categories for plastic surgeons decreased along with compensation as faculty or as speakers. Total charitable contributions and grant payments increased by 61 and 273%, respectively. Conclusion Analysis of industry–physician payments available through the Sunshine Act shows that the COVID-19 pandemic has significantly impacted industry payments to plastic surgery and its subspecialties. While this study demonstrates the economic impact of the current pandemic, only time will tell whether these trends will persist in the coming years. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.