Fee guidelines as applied to breast cancer surgery

The surgical fee benchmarks which were recently released allow contemplation of the stance taken by Ministry of Health for the treatment of breast conditions, in particular, breast cancer.

Most minimally invasive surgical procedures (MIS) are accorded the same codes as their conventional open counterparts. Fee guidelines are similar for both techniques and in rare instances, MIS procedures attract a higher professional fee.

Breast conservation surgery (BCS) is the minimally invasive form of surgical treatment for breast cancer. However, surgical codes and fee guidelines for BCS are consistently lower than those for the more traditional technique, mastectomy.

Since 2007, a substantial body of evidence has been accumulating indicating that BCS with radiotherapy results in better survival outcomes than mastectomy. Hence, BCS rates of at least 50 per cent for women with operable breast cancer is an essential criteria for institutions to be accredited as breast centres by the American College of Surgeons.

In Singapore, only 26 per cent of women undergo BCS.

If BCS is of lower technical difficulty as the surgical codes suggest, why are BCS rates not higher?

This begs the question whether the coding system of surgical procedures, which is directly related to remuneration, has an impact on the type of surgery performed. Are they appropriately structured after rigorous study to incentivise best surgical practice for breast cancer?

If not, could this lead to poor healthcare outcomes and further erosion of standards in the future?

Mona Tan

A version of this article appeared in the print edition of The Straits Times on December 17, 2018, with the headline 'Fee guidelines as applied to breast cancer surgery'. Print Edition | Subscribe