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Financial Disparities In Microsurgical Reconstruction: A Comparative Analysis Of Reimbursement For Head And Neck Versus Breast Free Flap Procedures
Ashlie Elver, MD, Matthew Sink, BS, Anna G. Boydstun, BS, Kendall C. Pitre, BS, Ron R. McCall, MS, Nancy K. Perry, MS, Laura S. Humphries, MD, Benjamin McIntyre, MD.
The University of Mississippi Medical Center, Jackson, MS, USA.
PURPOSE: Given the complexity of microsurgical reconstruction, understanding reimbursement patterns is essential for fair compensation and equitable access to care for patients requiring advanced reconstruction. This study aims to perform a comprehensive financial analysis comparing reimbursement trends in head and neck (H&N) flap reconstruction versus deep inferior artery perforator (DIEP) breast reconstruction.
METHODS:A retrospective review identified all patients undergoing H&N or DIEP flap reconstruction at a single institution from 2016-2023. Demographics, perioperative details, complications, payer status, and reimbursement data were collected. Descriptive and t-test analyses were used for statistical analysis.
RESULTS: A total of 136 H&N and 140 DIEP flap patients were reviewed. Table 1 summarizes the results. Providers received $4,322 more per patient and $7.19 more per operative minute for DIEP versus H&N flaps ($7,272 ± 5,003 vs. $2,950 ± 2,161; p<.0001). Medicaid reimbursement percentage greatly favored DIEP flaps (53.4% vs. 29.9%; p=.0034). Operative time was similar (DIEP: 569.8 ± 108.7 min vs. H&N: 546.7 ± 142.1 min; p=.133). Hospitals were reimbursed $32,337 more per H&N patient, a 7.7-day longer length of stay likely contributed (p<.0001).
CONCLUSION: This analysis highlights disparities in reimbursement for microsurgery, revealing undervaluation of H&N free flaps compared to breast microsurgery, which received higher compensation and Medicaid reimbursement despite comparable operative times and technical demands. Efforts toward transparent financial policies are needed to achieve fair reimbursement and equitable care.
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