More than Skin Deep
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Success key No. 1: Increasing awareness, increasing ROI
For greater ROI and improved patient outcomes, hospitals rely on breast reconstruction surgery following oncological procedures. Hospital systems, however, are concerned that they aren’t doing enough to get the message across about the availability of reconstructive surgery following a lumpectomy, or partial removal of the breast. If they do get the message across, there would be greater ROI for the hospitals as well as increased satisfaction for the patients, says Terry Myckatyn, MD, director of breast and cosmetic plastic surgery at the Washington University School of Medicine in St. Louis.
Breast cancer is one of the leading causes of cancer-related deaths, with 80% of breast cancers treated for breast conservation therapy such as a lumpectomy. Congress guaranteed universal coverage for breast reconstruction after cancer surgery in 1998, but nationally only 30%–40% of women who had mastectomies now receive breast reconstruction.
At Barnes-Jewish Hospital in St. Louis, where Myckatyn sees patients, about "70% of our patients who undergo mastectomy will have a reconstruction surgery, which is well above the national average," he says. The hospital attributes the tally to the hospital’s relationship with primary care physicians, as well as education programs.
"What dictates a patient having the surgery is referrals from a physician," Myckatyn says. "You can be in a referral pattern that detects more mammograms and detects more breast cancer. We are the downstream effect, basically, from that pattern."
Ultimately, "this is a complex procedure that requires more buy-in on the patient’s part," he adds.
State governments are taking steps to improve education about breast reconstruction. In New York, for instance, a law requires doctors and hospitals to discuss options for breast reconstruction with their patients before performing cancer surgery, to explain insurance coverage information, and to refer them to another hospital, if necessary, for reconstructive surgery, Myckatyn says.
Only now has the hospital begun to evaluate patient satisfaction scores related to plastic surgery and breast reconstruction.
"This is an area that has not been well studied largely because there is a lack of validated instruments to measure post-surgical satisfaction," Myckatyn says.
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