TMA Testimony: HB 669 Relating to Breast Reconstructive Surgery

Testimony: Committee Substitute House Bill 669 by Rep. James White (R-Woodville)

House Public Health Committee

Presented by: Debra Ann Patt, MD, MPH
April 20, 2011

Good morning, Chair Kolkhorst and members of the committee. My name is Debra Ann Patt. I am a physician in private practice at the Texas Oncology Cancer Center in Austin. I am board certified in oncology and hematology and have been caring for cancer patients for many years. I’m also a member of the Texas Medical Association’s (TMA’s) Committee on Cancer.

It is a privilege for me to speak with you today on behalf of TMA, which represents 45,000 physicians and medical students.  I am here today to express our concerns about the committee substitute for House Bill 669 (CSHB 669). The committee substitute mandates that physicians provide specific instructions and care to women with breast cancer. These are the very patients I treat and care for every day.

We absolutely agree that a woman facing surgery for breast cancer should be informed about her options for breast reconstruction. This dialogue and exchange of information is an important step between the physician and patient before she has breast cancer surgery. While CSHB 669 attempts to foster that dialogue — it takes us in the wrong direction by dictating what physicians must tell their patient facing breast cancer surgery. 

CSHB 669 mandates that physicians provide a description of each reconstructive option including information on insurance coverage before scheduling a surgical procedure with their patient. This prescriptive language greatly concerns us for several reasons.

One, some breast cancer surgery, such as a lumpectomy, is performed with the intention of conserving the breast. Breast reconstruction may not be necessary. We believe that providing so much information on all options may be confusing and even misleading to the patient.

Two, breast cancer is personal. The discussion between a patient and her doctor on her options for breast reconstruction is extremely variable and individualized. No two patients or their breast cancer treatment is exactly the same. That’s why before discussing breast reconstructive surgery, we first must consider at least these factors:

  • Age,
  • Overall health and prior medical history or surgeries,
  • Body shape and other factors such as a history of smoking,
  • Stage of her cancer and diagnosis for the woman and whether further cancer treatment is planned, and
  • Whether she wants breast reconstructive surgery immediately, at a later period, or if at all.

Every patient having breast cancer surgery has many concerns and complex decisions to make. Breast reconstruction may not be an immediate concern for a woman who has just received a breast cancer diagnosis. Over the course of her breast cancer treatment, a strong relationship develops between the patient and her team of physicians and other health care workers. This team is critical in the management and coordination of her care.

While this legislation is well intended, we do not believe it accomplishes what it sets out to do. Again, this is a very personal decision. Many women I treat don’t want reconstructive surgery. Some women can’t have reconstructive surgery, even if they do want it.

Also, the bill’s requirement for physicians to provide their patients a description of provisions assuring patients of cost coverage by public and private insurance plans is impossible for physicians or their staff to meet. A physician cannot assure the patient that her breast reconstruction will be covered and to what degree. Physicians, even with best efforts at verification of eligibility and preauthorization from the insurer, cannot be expected to make that type of guarantee. Every day in my office I receive denials or partial payments for services that my staff verified appropriately and prior authorized. As much as physicians would like to know this information, all we can do is make a best effort to provide a “ball park” idea of what might be covered. An absolute assurance is not feasible and is an unrealistic expectation.

Texas lawmakers have demonstrated a strong commitment to preventing and fighting breast cancer. Texas was among the first states to pass a law that all women should be told about reconstructive surgery coverage. Lawmakers also chose to protect Texas’ low income women by authorizing expanded screening for breast and cervical cancer and treatment for their cancer under Medicaid. These efforts were based on dozens of peer-reviewed studies — some done in Texas that showed that low-income women did not have adequate access to breast cancer screening, diagnosis, and treatment. Hundreds of women are alive today because of the support you provided for this well-researched cancer screening and treatment program.

The provisions in CSHB 669 have not been studied as thoroughly, if at all. We believe they need further study to ensure women going through cancer treatment definitely need them. I thank you for your attention and welcome any questions you may have.

82nd Texas Legislature Testimonies


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