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• W4377013414 abstract "PURPOSE: he incidence of head and neck cancers (HNC) is increasing, with a shift in the dominant disease pathophysiology to HPV. Financial support for HNC is critical to ensuring equitable access to care for this growing patient population. Comparison of non-profit support, reimbursement rates and hospital-associated costs for HNC patients relative to other patients requiring complex reconstruction may help to illuminate care disparities. METHODS: The National Institute of Health’s “Support Service Locator” and IRS tax exempt organization tool was queried to identify existing non-profit support. Pricing data was abstracted from the Centers for Medicare and Medicaid Services Physician Fee Schedule Look-Up Tool. Inflation-adjusted reimbursement data for reconstructive procedure CPT codes was calculated for fiscal years 2012 to 2021. Student’s t-test was used to determine statistical significance. Publicly accessible patient-level data for 2015 to 2017 was acquired from the New York State Department of Health and analyzed in R Studio (v1. 3.1). HNC and BC patients admitted for procedures relating to cancer care were identified using MDC, CCS and APR-DRG codes. Wilcoxon-Mann-Whitney tests for statistical significance were used for inter-group and subgroup analyses. RESULTS: When compared to breast cancer (BC), HNC has substantially fewer support groups (2 versus 8), tax-exempt organizations (11 versus 639) and grant funding ($75 million versus $614 million). Procedure reimbursements for free and pedicled flaps indicate that HNC reconstruction procedures are reimbursed significantly lower than those for breast and the lower extremities (p < 0.01). Notably, a unilateral DIEP reconstruction reimburses in line with a free osteocutaneous flap. Analysis of patient data across New York State demonstrates that cancer patients hospitalized for HNC procedures were more likely to have public insurance, require longer lengths of stay, and generate higher hospital costs than cancer patients hospitalized for BC procedures (p < 0.01). Within HNC patients, publicly insured patients had significantly longer lengths of stay and higher costs per day than privately insured patients (p < 0.01). CONCLUSION: Reimbursements for myocutaneous HNC reconstructive procedures are significantly lower than BC and extremity reconstructive procedures of comparable work effort; notably, a unilateral deep inferior epigastric perforator reconstruction is reimbursed the same amount as a free osteocutanous flap requiring significantly more work effort. Further, there is far less non-profit support for HNC patients than BC patients. HNC patients are more likely to be publicly insured and have longer lengths of stay than patients undergoing breast reconstruction. The higher cost of care for HNC patients and large discrepancy in reimbursement may financially disincentivize investment in care for HNC patients and limit future access to care in this patient population." @default.
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• W4377013414 date "2023-05-01" @default.
• W4377013414 modified "2023-09-30" @default.
• W4377013414 title "141. Financial Disincentives for Surgical Reconstruction in Head and Neck Cancer Care" @default.
• W4377013414 doi "https://doi.org/10.1097/01.gox.0000938152.94326.60" @default.
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