Geographic Disparities and Payment Variation for Immediate Lymphatic Reconstruction in Massachusetts

Area of Science:

• Oncology
• Plastic Surgery
• Lymphedema Management

Background:

• Practice patterns and payment data for immediate lymphatic reconstruction (ILR) are not well-established.
• ILR is a surgical intervention aimed at preventing or managing lymphedema following cancer treatment.

Purpose of the Study:

• To evaluate trends in the delivery and billing practices of ILR.
• To identify factors associated with ILR utilization.

Main Methods:

• Analysis of the Massachusetts All-Payer Claims Database (2016-2020).
• Inclusion of patients undergoing lumpectomy or mastectomy with axillary lymph node dissection for oncologic indications.
• Identification of patients who underwent lymphovenous bypass on the same day as tumor resection.
• Geographic distribution analysis using ZIP code data and physician payment calculations.
• Multivariable logistic regression to determine predictors of ILR receipt.

Main Results:

• 53 out of 2862 patients (1.8%) underwent ILR.
• Patients receiving ILR were younger and more likely to have received radiation therapy.
• Residing in a county near Boston significantly increased the odds of undergoing ILR (3.32-fold).
• Obesity, radiation therapy, and taxane-based chemotherapy were not significant predictors of ILR receipt.
• Physician payments for ILR demonstrated wide variability.

Conclusions:

• Geographic disparities exist in ILR access, with higher utilization near Boston.
• Patients at high risk for breast cancer-related lymphedema may face access barriers to ILR.
• Increased awareness and referrals to plastic surgeons for high-risk patients are necessary.