Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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The Effect of Medicaid Expansion on Utilization of Post-Mastectomy Breast Reconstruction
Oluseyi Aliu, MD, MS, Aviram M. Giladi, MD, MS, Kevin C. Chung, MD, MS.
University of Michigan, Ann Arbor, MI, USA.

Purpose: With Medicaid expansion continuing under the Affordable Care Act, it is important to understand the potential effects of coverage on delivery of reconstructive services to new beneficiaries. The effects of changes in public health care coverage on breast reconstruction are not known. We assessed utilization of different types of breast cancer reconstruction by Medicaid beneficiaries after Medicaid expansion in New York State (NY) in 2001.
Methods: We used the State Inpatient Database for NY (1998-2006). We selected all patients 19-64 years old who underwent breast cancer reconstruction, and classified by autologous or prosthetic reconstruction. We used an interrupted time series design with linear regression modeling to evaluate the effect of Medicaid expansion on the proportion of breast cancer reconstruction patients that were Medicaid beneficiaries.
Results: The proportion of breast cancer reconstruction cases provided to Medicaid beneficiaries increased by 0.28% per quarter after expansion (p<0.001), resulting in a 5.5% increase above predicted trajectory had there been no expansion. This corresponds to an increase of 1.8 Medicaid cases per 1,000,000 NY population per quarter. On subgroup analysis, we found no significant increase in proportion of autologous reconstruction cases for Medicaid beneficiaries (p=0.4; Figure 1). However, the proportion of prosthetic reconstruction for Medicaid beneficiaries had a significant increase of 0.41% per quarter (p<0.001; Figure 2), resulting in a cumulative increase of over 7.5%. This indicates that 135 additional prosthetic reconstruction surgeries were provided to NY Medicaid beneficiaries annually within 5 years of expansion, with no change in autologous procedures over that same post-expansion period.
Conclusions: Plastic surgeons responded to the expansion of Medicaid by increasing volume of breast reconstruction provided to Medicaid beneficiaries. However, there are additional barriers to autologous breast reconstruction, likely related to operational and reimbursement disparities, that were unchanged by the increase in Medicaid coverage. If Medicaid expansion is to provide comprehensive care, with adequate access to all reconstructive options, these barriers must be addressed.

Figure 1: Interrupted time series results showing probability of Medicaid as the primary payer for autologous breast reconstruction. Expansion occurs at 15th quarter (red line).

Figure 2: Interrupted time series results showing probability of Medicaid as the primary payer for prosthetic breast cancer reconstruction. Expansion occurs at 15th quarter (red line).


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