203 posters, 14 topics, 5 sessions, 817 authors, 256 institutions
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The AAPS 102nd Annual Meeting
May 18-21, 2024 | The Westin Copley Place, Boston, MA
D87
The Association Of Surgeon Density On Breast Reconstruction Access, Outcomes, And Cost In The United States
Poster Presenter
Authors
Affiliations
University of Michigan, Research Fellow, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Department of Biostatistics, University of Michigan School of Public Health, Medical Student, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Professor, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
Part of Topic
Breast Reconstruction
impact of Regional Surgeon Competition on Use, Cost, and Outcomes of Breast Reconstruction in the United States
Joseph N. Fahmy, MD, MS1; Jacob S. Nasser, MD1; Hao Wu, MS2; Lu Wang, PhD2; Kevin C. Chung, MD, MS1
1.Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA 2. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
STUDY PURPOSE
Multiple economic forces influence costs and access to healthcare in the united states. Though prior studies have investigated the impact of competition between hospitals, finding increased access to procedural care, no study has evaluated the impact of competition between surgeons and its impact upon cost or use of postmastectomy breast reconstruction.
METHODS
A retrospective cross-sectional analysis using Marketscan claims data from 2009 to 2020 was performed. The Herfindahl-Hirschman Index (HHI), a measure of market concentration, was calculated using the sum-of-squares of the proportion of breast reconstruction cases performed by each surgeon in a metropolitan statistical area (MSA). Multivariable logistic regression was used to identify differences in rates, outcomes, and costs of reconstruction by HHI for the 15,002 patients in the study cohort.
Greater competition among surgeons is associated with improved access to reconstructive surgery, but no difference in cost. Application of this evidence may include system-level strategies to bolster care coordination, while targeting drivers of cost, such as hospitals and hospital systems, through policy.