Summer 2016

The Costs and Complications Associated with Repeated Breast-Conserving Surgeries

Women who undergo partial mastectomies (also known as breast-conserving surgery or lumpectomy) sometimes have a second operation to remove remaining tissue that a pathology report suggest still contains a few tumor cells. Research, though, indicates that the repeat surgeries depend less on the patient than they do on the surgeon reading the reports.

Time magazine, quoting a study published in the Journal of the American Medical Association, reported that rates of repeat surgery varied between 0 percent and 70 percent depending on the surgeon and from 1.7 percent to 21 percent depending on the hospital.

“The study found that nearly half of the repeat surgeries were done in women whose pathology reports showed no evidence of residual tumor cells,” the magazine reported.

What Our Claims Analysis Reveals
Last year, Blue Cross and Blue Shield of Texas (BCBSTX) teamed up with industry experts Diagnostic Photonics Inc. of Chicago and the University of Texas MD Anderson Cancer Center in Houston to take a closer look at the often unnecessary and expensive follow-up lumpectomies women undergo. The study, presented at the American Society of Clinical Oncology in June, found evidence that women who undergo additional breast surgery often suffer medical complications associated with the follow-up surgery.

The study analyzed private claims data for close to 10,000 Blue Cross and Blue Shield members in Illinois, New Mexico, Oklahoma and Texas who had lumpectomies between January 2010 and December 2013. The study found:

Next Steps to Help Improve Outcomes
The next step with this ongoing project is to see how we can improve surgical outcomes for our members – and reduce cost – by exploring a low-cost technology solution that will reduce the excess breast tissue removed, and avoid complications and repeat surgeries.

We also want to look deeper into the variation in care to understand what drives the incident of repeat surgeries, and how and where access to new technology can be most beneficial. The study will also help us understand how to price the new technology in order to make sure it improves the quality of care our members have access to.

We are committed to adding to the national health care dialogue by offering cost-effective and patient-centric solutions, based on clinical analytics that aim to make the health care system work better. Our collaboration with leaders within the health care industry is designed to enhance the patient experience, significantly reduce cost savings for members and employers, and give providers the insight to work at optimal levels.