Protecting DIEP flap as a Reconstruction Option
Recently, VBCF joined the Community Breast Reconstruction Alliance (CBRA), a group of patient advocacy organizations and healthcare providers who are working together to advocate for access to deep inferior epigastric perforator (DIEP) flap breast reconstruction surgery. Access to DIEP flap reconstruction is at risk because the federal Centers for Medicare and Medicaid Services (CMS) announced plans to eliminate three procedure insurance codes and instead group all autologous (or "flap") breast reconstruction surgeries under the same insurance code. Some health plans are moving quickly to use the new code and only reimburse for less advanced surgery and/or reduce payment for DIEP flap procedures. If action is not taken, DIEP flap surgery may only be an option for those who can pay out of pocket for the surgery - at a cost of up to $50,000 or more.
What is DIEP flap reconstruction surgery?
DIEP flap breast reconstruction is a specialized surgery that allows individuals to use their natural tissue to rebuild their breast(s) rather than using implants. The use of natural tissue results in lifelong breast reconstruction, as opposed to implant-based reconstruction because implants must be replaced after 10 or 15 years. DIEP flap surgery also differs from other flap reconstruction procedures, such as TRAM flap, because it uses advanced microsurgery to preserve a person's abdominal muscles. This procedure creates better long-term health outcomes than older surgeries that removed a patient's muscle.
Why is DIEP flap at risk?
Access to DIEP flap reconstruction is at risk because the Centers for Medicare and Medicaid Services (CMS) announced plans to eliminate three procedure codes, and some health plans are moving quickly to use the new code and reduce payment for DIEP flap. If medical providers can only bill insurance for a less expensive surgery option, it will be left to patients to make up the difference in cost and, therefore, finanically out of reach for many. VBCF believes breast cancer patients should have affordable access to all reconstruction options and choose which one is best for them in consultation with their doctor.
Take Action:
1) Are you considering or have you had DIEP flap surgery? We want to hear from you! Please get in touch with VBCF's Policy Manager, Kirsta Millar (kirsta@vbcf.org) if you are willing to share your experience. Your story will help us as we advocate on this issue.
2) Sign the Petition: Individual advocates can sign this letter to CMS asking them to reverse the decision to eliminate the code for DIEP flap breast reconstruction surgeries.
3) Go to the Community Breast Reconstruction Alliance webpage to learn other ways you can take action.
