Patients enrolled in Medicare and Medicaid will retain coverage for a safer and preferred method of breast reconstruction surgery, thanks to the spirited advocacy of an Austin plastic surgeon as well as the Texas Medical Association and others in organized medicine.
The Centers for Medicare & Medicaid Services’ (CMS) original plan to eliminate procedure codes related to deep inferior epigastric perforator (DIEP) flap surgery – set to take effect in January 2025 – sparked concerns over patient safety and access to care, with implications for practice viability.
Austin plastic surgeon Elisabeth Potter, MD, who led the opposition, said axing such coverage would force vulnerable patients to choose between an inferior technique – including one that uses muscle to reconstruct the breast and could cause lifelong medical problems – and paying out of pocket. The DIEP microsurgical technique rebuilds a patient’s breast with her own tissue.
“Anything that affects access through insurance to breast reconstruction is going to be devastating to the community of patients affected by breast cancer,” she told Texas Medicine Today. “Fighting cancer is financially devastating. If you harm a patient by knowingly inflicting financial distress on them, then you have not lived up to the standard of being a physician who cares for cancer patients.”
She also worried CMS’ original plan signaled a broader lack of interest in women’s health.
“Having to undergo a surgery that would remove your core strength if you wanted to have a breast reconstruction – that just doesn’t meet the modern expectations for women’s health.”
Her spirited advocacy earned commendation from U.S. Rep. Debbie Wasserman Schultz (D-Florida) in an Aug. 23 press release.
“Saving access to DIEP flap breast reconstruction option required CMS to reverse course, and that would not have happened if not for my diligent congressional colleagues, cancer advocacy groups, watch-dog journalists and dedicated medical professionals, especially Dr. Elisabeth Potter,” Representative Wasserman Schultz said.
And in an Aug. 22 memo, CMS called attention to the “substantial number of responses” it received from nearly 300 physicians, patients, and numerous associations – including Dr. Potter and TMA – concerned about its plan to eliminate coverage of DIEP flap surgery.
“The majority of the commenters feel their accessibility will be, or has already been, impacted by the decision to eliminate the [procedure] codes,” the federal agency wrote, explaining its reversal.
CMS’ original plan had other consequences, Dr. Potter adds, including spurring private payers to rescind coverage, thus jeopardizing the viability of physician practices that provide the procedure.
The policy change, Dr. Potter says, validates her wading into politics and years-long investment in the issue.
“I’m a microsurgeon. I’m incredibly busy. But if I don’t do this, no one else will.”
Emma Freer
Associate Editor
(512) 370-1383