Reimbursement Trends in Reduction Mammoplasty: A Single-Center Analysis of Insurance Reimbursements From 2012 to 2021.

BACKGROUND: Medicare reimbursement for plastic surgery procedures increased by 2% while inflation increased by 19% in the past decade. Given increasing national breast reduction case volume and the negative impact decreased reimbursements have on surgeon well-being, we sought to evaluate actual surgeon reimbursements for bilateral breast reduction over a decade. METHODS: A retrospective review was performed including all identifiable breast reduction procedures (Current Procedure Terminology 19318) performed at a tertiary academic hospital between October 2011 and September 2021 (fiscal year 2012-2021). The annual number of patients undergoing breast reduction, the payor, and average yearly amounts reimbursed were evaluated and trended over time. Percent change from Medicare average yearly reimbursements was evaluated and trended over time. All values were adjusted to 2021 US dollars. RESULTS: During our study period, there were 486 bilateral breast reduction procedures with 36 outlier payments; therefore, 450 reimbursements were included in the study. There were 5 payors, and the average adjusted reimbursement amount was $2418.74 ± $1123.83. All private payors had significantly higher average reimbursement than Medicare ( P < 0.0001), and Medicare was the only payor with significant decrease in reimbursement over time (-$58.58 per year, 95% confidence interval, -$110.80 to -$6.33, P = 0.033). CONCLUSIONS: Our data demonstrate that a difference exists between public and private payors for bilateral breast reduction procedures. Private payor reimbursements outpaced inflation. Medicare is an unreliable benchmark that may indirectly lead to declining reimbursements over time.

Acinar cell induced autolysis is a frequent occurrence in CytoLyt-fixed pancreatic fine needle aspiration specimens: An analysis of 157 cytology samples.

BACKGROUND: Although 10% formalin is a standard preservative in pancreatic FNAs, the effect of CytoLyt on pancreatic tissue preservation has not been systematically explored. METHODS: Smears and cell blocks from CytoLyt-fixed (CF-CBs) and formalin-fixed (FF-CBs) pancreatic FNAs were blindly reviewed without knowledge of the fixative used, and the presence of tissue/tumor autolysis was noted. Controls included FF-CBs from pancreatic FNAs, CF-CBs from nonpancreatic FNAs, and 4 pancreatic FNAs with matched CF-CBs and FF-CBs. RESULTS: We found that 62 of 85 (73%) pancreatic FNAs with CF-CBs showed significant autolysis, which was most pronounced in acinar cells and/or tumor cells with benign acinar cells in the background, compared with 2 of 46 (4%) FF-CBs (P < .0001) and 3 of 26 (12%) CF-CBs from nonpancreatic FNAs (73% vs 12%; P < .0001). Of the 4 pancreatic FNAs with matched CF-CBs and FF-CBs, all 4 CF-CBs showed marked autolysis versus none of the matched FF-CBs. Of the 23 (27%) pancreatic FNAs with CF-CBs that did not show autolysis, 10 had no acinar cells, and 7 had only minute tissue fragments on CB. CONCLUSION: While CytoLyt is a useful fixative for nonpancreatic FNAs it is a suboptimal fixative for pancreatic FNAs and is associated with tissue/tumor autolysis in the majority of cases, influencing morphologic evaluation, and potentially immunocytochemical staining. Autolysis appears to be due to acinar enzymes whose effect is likely interrupted/inhibited by formalin fixation. Cytopathologists and cytotechnologists should be mindful of this pitfall and should avoid using CytoLyt as a fixative for pancreatic FNAs.

A Cohort Analysis of Postbariatric Panniculectomy--Current Trends in Surgeon Reimbursement.

BACKGROUND: The overall number of patients undergoing body contouring procedures after massive weight loss (MWL) has progressively increased over the past decade. The purpose of this study was to evaluate the charges and reimbursements for panniculectomy after MWL at a large academic institution in Massachusetts. METHODS: A retrospective review was performed and included all identifiable panniculectomy procedures performed at our institution between January 2008 and January 2014. The annual number of patients undergoing panniculectomy, the type of insurance coverage and reimbursement method of each patient, and the amounts billed and reimbursed were evaluated. RESULTS: During our study period, 114 patients underwent a medically necessary panniculectomy as a result of MWL. The average surgeon fee billed was $3496 ± $704 and the average amount reimbursed was $1271 ± $589. Ten cases (8.8%) had no reimbursements, 31 cases (21.8%) reimbursed less than $1000, 66 cases (57.9%) reimbursed between $1000 and $2000, and no cases reimbursed the full amount billed. When evaluated by type of insurance coverage, collection ratios were 37.4% ± 17.4% overall, 41.7% ± 16.4% for private insurance, and 24.0% ± 13.0% for Medicare/Medicaid insurance (P < 0.001). CONCLUSIONS: Reimbursements for panniculectomy are remarkably low, and in many instances, absent, despite obtaining previous preauthorization of medical necessity. Although panniculectomy is associated with improvements in quality of life and high levels of patient satisfaction, poor physician reimbursement for this labor intensive procedure may preclude access to appropriate care required by the MWL patient population.

Evaluation of abdominal cutaneous sensibility following abdominoplasty.

BACKGROUND: Cutaneous hypesthesia is an undesirable postoperative outcome following abdominoplasty. The purpose of this study was to evaluate postabdominoplasty cutaneous sensibility using clinical, quantitative, and reproducible methods. METHODS: Thirty patients who underwent abdominoplasty were divided into three groups: 0 to 12 months (short-term follow-up), 12 to 24 months (intermediate-term follow-up), and greater than 24 months (long-term follow-up) following abdominoplasty. Abdominal skin was divided into 12 areas, and superficial tactile sensibility was assessed subjectively using a patient questionnaire and objectively using Semmes-Weinstein monofilaments. Statistical analysis was performed using the t test, with significance defined as p ≤ 0.05. RESULTS: Seventeen patients (56.7 percent) subjectively reported the presence of any abdominal cutaneous sensibility change postoperatively. Of those, 82.4 percent reported indifference toward this outcome. The greatest degree of objective sensibility loss was noted in area 8 (infraumbilical), followed by areas 5 (supraumbilical) and 11 (midline infraincisional). In these areas, there were statistically significant decreases in the average cutaneous pressure thresholds between the short-term and intermediate-term follow-up groups, the intermediate-term and long-term follow-up groups, and the short-term and long-term follow-up groups. CONCLUSIONS: Postabdominoplasty cutaneous sensibility losses improve over time. These findings may enable plastic surgeons to better inform their patients regarding the risk of sensibility loss and the longitudinal outcome of such changes postoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Should a panniculectomy/abdominoplasty after massive weight loss be covered by insurance?

Body contouring after massive weight loss (MWL) is a rapidly growing area in Plastic Surgery. Panniculectomy/abdominoplasty is primarily a cosmetic procedure with some functional benefits (a large pannus may hamper mobility, prevent further weight loss, and cause recurrent skin infections) and hence many insurance companies are changing their guidelines to include this as a medical procedure. This study assesses reimbursements for a large academic institution in Massachusetts for panniculectomies/abdominoplasties performed in MWL patients. We performed a retrospective review of charges and reimbursements for panniculectomy/abdominoplasty in MWL patients performed at Lahey Clinic. Records for patients who underwent a "medical" panniculectomy by a single surgeon from August 2002 to August 2006 were reviewed with special emphasis on the charges, reimbursements, insurance carriers, and prior preauthorizations. Fifty-two patients underwent a medical panniculetomy/abdominoplasty (Current Procedural Terminology code 15831) for laxity of skin/pannus as a result of MWL. All patients except Medicare required and obtained precertification for the procedure. Patient ages ranged from 35 to 59 years, which included 42 females and 10 males (n = 52). Forty-three underwent bariatric surgery; their procedures were performed between 13 and 62 months after their initial surgery. Weight loss ranged from 65 to 345 pounds. Body mass index at the time of the surgery ranged from 22 to 48. The standard surgical charge for a medical panniculectomy at Lahey Clinic is $3,086. The range of reimbursements was zero to the full amount with the mean reimbursement of $615 and the median being $899. Reimbursements for panniculectomies are remarkably low and in many instances (35% in our series) absent despite obtaining prior precertification of medical necessity. Although insurance companies have extended their indications for panniculectomy/abdominoplasty, we think that it is a cosmetic procedure. Plastic surgeons must bear these reimbursements in mind when faced with a patient requesting this.

Optimal parameters for marking upper blepharoplasty incisions: a 10-year experience.

Although a variety of techniques for upper blepharoplasty have been described, few studies illustrate and clinically evaluate a system for marking incisions. Presented is a 10-year experience using a specific method for marking upper blepharoplasty incisions that consistently yielded excellent esthetic results. All upper blepharoplasties performed by the senior author between April, 1994 and April, 2004 were reviewed. Markings were designed to end the medial incision 6 mm from the angular vein, end the lateral incision 12 mm from the palpebral fissure, and to extend the incisions superiorly at 45 degrees. Over 10 years, 476 patients underwent cosmetic upper blepharoplasty. There were 22 (4.6%) revisions. Eighteen (3.8%) were performed in clinic using CO2 laser, and 4 (0.8%) patients required surgical revision. Patient satisfaction was high, and no scars were visible outside the brow. Excellent outcomes can be expected using this simple, reproducible, and widely applicable system for marking upper blepharoplasty incisions.