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. 2025 May;32(5):3695-3704.
doi: 10.1245/s10434-024-16738-z. Epub 2024 Dec 24.

Lower Commercial Rates for Breast Surgical Procedures are Associated with Socioeconomic Disadvantage: A Transparency in Coverage Analysis

Danielle H Rochlin  1 , Yang Wang  2 , Uchechukwu O Amakiri  3 , Jacob Levy  3 , Lillian Boe  4 , Clifford C Sheckter  5 , Gerard Anderson  2 , Babak J Mehrara  3 , Jonas A Nelson  3 , Evan Matros  3
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Lower Commercial Rates for Breast Surgical Procedures are Associated with Socioeconomic Disadvantage: A Transparency in Coverage Analysis

Danielle H Rochlin et al. Ann Surg Oncol. 2025 May.

Abstract

Background: The Centers for Medicare & Medicaid Services (CMS) implemented the Transparency in Coverage Rule in 2022, which requires payers to disclose commercial rates for the first time in the history of the US healthcare system. The purpose of this study was to characterize payer-disclosed commercial facility rates and examine the relationship with county-level social disadvantage for common breast surgical procedures.

Materials and methods: We performed a cross-sectional study of 2023 pricing data for 14 ablative and reconstructive breast procedures from Turquoise Health. Socioeconomic disadvantage was quantified using the Social Vulnerability Index (SVI). Within- and across-payer ratios quantified rate variation. Linear regression assessed the relationship between relative value unit (RVU)-adjusted median commercial rates and facility-level variables including SVI quartile.

Results: There were 4,748,074 unique commercial rates disclosed by four payers from negotiations with 10,023 hospitals. Rates varied by a factor of 9.8-15.6 within and 10.0-18.1 across payers. RVU-adjusted commercial rate decreased in a stepwise fashion as SVI quartile increased and varied by payer (p < 0.001). Higher RVU-adjusted rates were associated with hospitals compared with ambulatory facilities (β = 138, 95% CI 138-139, p < 0.001). Lower rates were associated with areas of less healthcare infrastructure (β = - 37, 95% CI - 38 to - 37, p < 0.001).

Conclusions: Facility rates for breast surgical procedures varied significantly within and between payers and were higher for hospitals compared with ambulatory surgery centers. Facilities in areas of higher social vulnerability were associated with lower negotiated rates. The health equity implications of lower payment in areas of higher disadvantage, particularly in terms of access to care, deserve further investigation.

Keywords: Breast surgery; Commercial facility rates; Health equity; Price variation; Social vulnerability index; Transparency in coverage.

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Conflict of interest statement

Disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Babak J. Mehrara, MD, is the recipient of investigator-initiated research grants from Pfizer, Integra, and Regeneron and has received royalty payments from Elsevier; he also has served as a consultant for Mediflix Corp. Yang Wang, PhD, and Gerard Anderson, PhD, receive funding from Arnold Ventures LLC. Jonas Nelson has served as a consultant for RTI surgical. This research was supported in part by the Cancer Center Support Grant P30 CA008748 that supports the research infrastructure at Memorial Sloan Kettering Cancer Center. In addition, Clifford C. Sheckter, MD, is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR003143. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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References

    1. Coughlin SS. Social determinants of breast cancer risk, stage, and survival. Breast Cancer Res Treat. 2019;177(3):537–48. https://doi.org/10.1007/s10549-019-05340-7 . - DOI - PubMed
    1. Fwelo P, Nwosu KOS, Adekunle TE, et al. Racial/ethnic and socioeconomic differences in breast cancer surgery performed and delayed treatment: mediating impact on mortality. Breast Cancer Res Treat. 2023;199(3):511–31. https://doi.org/10.1007/s10549-023-06941-z . - DOI - PubMed
    1. Bauder AR, Gross CP, Killelea BK, Butler PD, Kovach SJ, Fox JP. The relationship between geographic access to plastic surgeons and breast reconstruction rates among women undergoing mastectomy for cancer. Ann Plast Surg. 2017;78(3):324–9. https://doi.org/10.1097/sap.0000000000000849 . - DOI - PubMed
    1. Butler PD, Morris MP, Momoh AO. Persistent disparities in postmastectomy breast reconstruction and strategies for mitigation. Ann Surg Oncol. 2021;28(11):6099–108. https://doi.org/10.1245/s10434-021-10487-z . - DOI - PubMed
    1. Sisco M, Du H, Warner JP, Howard MA, Winchester DP, Yao K. Have we expanded the equitable delivery of postmastectomy breast reconstruction in the new millennium? Evidence from the national cancer data base. J Am Coll Surg. 2012;215(5):658–66. https://doi.org/10.1016/j.jamcollsurg.2012.07.008 . - DOI - PubMed

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