Important News for Breast Reconstruction Patients: CMS DIEP Flap S-Code Decision
The Centers for Medicare & Medicaid Services (CMS) has made a decision about how modern, muscle-preserving breast reconstruction procedures like the DIEP flap are coded for billing purposes. This decision comes after receiving valuable feedback from patients and healthcare providers on the plan to sunset the “S-codes”, emphasizing the increasing importance of the patient’s voice and patient advocacy in healthcare policy decision-making.
The CMS Decision
CMS originally planned to sunset the S codes used by surgeons and insurance companies for reimbursement of complex breast reconstruction procedures like the DIEP flap. However, they reversed course after listening to feedback from patients and healthcare providers like your doctors. “We will be maintaining HCPCS Level II codes S2066, S2067, and S2068 and will not sunset their availability on December 31, 2024.”
Why Were The Breast Reconstruction Codes Scheduled To Sunset?
CMS wanted to simplify how they label different breast reconstruction surgeries. They believed that using specific codes could help both doctors and insurance companies communicate better about these procedures. However, they now understand that the changes could have caused confusion and would limited affordable patient access to modern breast reconstruction options through insurance.
What Stays the Same?
CMS has decided not to make any S-code changes for now. The current codes that describe breast reconstruction procedures will remain in place for the time-being. This means that your access and insurance coverage for these surgeries should not be affected for the foreseeable future.
What Does This Mean for You?
If you’re planning to have a breast reconstruction procedure, this news means that you won’t have to worry about any sudden changes in how your insurance covers the surgery. The codes that your surgeon(s) use to bill insurance companies will also stay the same.
What Can You Do?
Keep using your voices and communicating with your doctors and healthcare providers about your breast reconstruction plans. If you have questions or concerns about insurance coverage, please be sure to ask them for guidance. They are here to help you understand your options and the potential impact of any changes in the insurance landscape that could impact your care or access to it. Patient advocacy works!
How Patient Advocacy and Shared Decision-Making are Changing Breast Cancer Care
The rise of patient advocacy and shared decision-making are transforming breast cancer care.
Shared decision-making is a process whereby the patient and physician participate in the medical decision-making process together. The approach considers all evidence-based treatment options and associated risks, the physician’s expertise, together with the patient’s preferences, values and expectations to arrive at the best treatment plan for the patient. Multiple studies show this collaborative approach improves patient outcomes and satisfaction.
Empowered, self-educated patients are increasingly advocating for themselves, seeking to have a greater voice in their treatment planning. As the only shared decision-making breast cancer app in the World, Breast Advocate® is very proud to be able to facilitate the patient advocacy movement.
Now, patient advocacy is also making positive strides in the research arena. Nowhere has this been more evident than at the 2018 San Antonio Breast Cancer Symposium last month, where patients have become an integral part of the meeting. By participating on panels, asking questions and weighing in on research, patients have “shifted the direction of breast cancer research,” says Dr. Elaine Schattner. “By speaking up, advocates at the meeting have shifted the direction of breast cancer research. Some are alive, improbably, as a consequence of new treatments enabled and promoted by their advocacy.”
Collaboration can only make things better. We look forward to patient advocates having a constant seat at the table at many more scientific meetings!
Breast Advocate Founder Moderates Shared Decision-Making Panel At ASPS ‘The Meeting’
Breast Advocate’s Founder Dr. Minas Chrysopoulo this month had the honor of moderating a panel on the importance of shared decision-making in breast reconstruction at this year’s American Society of Plastic Surgeons (ASPS) annual meeting in Chicago. ‘The Meeting’ is the largest plastic surgery meeting in the World and welcomes surgeons from all over the globe. Dr Chrysopoulo had the privilege of being joined on the panel by Breast Advocate co-contributor Dr Hani Sbitany, and patient advocates Terri Coutee and Kirstin Litz.
“Once upon a time, I’d tell a patient their breast reconstruction options and the associated risks and recommend what I thought was best. Then I discovered shared decision-making and it changed my practice forever,” shared Dr. Minas Chrysopoulo.
What exactly is “shared decision-making”?
Shared decision-making is the conversation and information exchange that happens between a patient and their healthcare professional to reach a treatment plan together. The doctor ensures the patient is fully educated about all their treatment options and the associated risks, while the patient shares their preferences, values and any other personal factors that are important in reaching the best plan for the patient.
Shared decision-making flies in the face of the paternalistic approach to healthcare delivery and instead empowers patients to have an equal voice in their treatment planning – It was the driving philosophy behind the creation of the Breast Advocate App.
Listen to the entire shared decision-making presentation here.
