Robert Weiss
Lymphedema Patient Treatment Advocate, USA
Scientific Tracks Abstracts: Gen Med (Los Angeles)
Statement of the Problem: Treatment of chronic illness accounts for over 90% of Medicare spending. Chronic lymphedema places over 3 million Americans at risk of recurrent cellulitis. Health insurers and legislators have taken an active role in fighting attempts to mandate the treatment of lymphedema for fear that provision of the physical therapy and compression materials would result in large and uncontrollable claim costs. Published studies compare cost of treatment versus cost of non-treatment for a select group of lymphedema patients. They do not provide the data necessary for insurance underwriters’ estimations of expected claim costs for a larger general population with a range of severities, or for legislators’ evaluations of the costs of proposed mandates to cover treatment of lymphedema. Methodology: The Commonwealth of Virginia has had a lymphedema treatment mandate since 2004. Reported data for 2004–2019, representing 80% of the Virginia healthcare insurance market, contains claims and utilization data and claims-based estimates of the premium impact of its lymphedema mandate. Findings: The average actual annual lymphedema claim cost was $2.03 per individual contract and $3.54 per group contract for the years reported, representing 0.05 and 0.08 % of average total claims. The estimated premium impact ranged 0.16–0.32% of total average premium for all mandated coverage contracts. Office visits decreased 6.49% and hospitalizations decreased 16.47% over the 16-year period. Conclusions: Ten years of insurance experience with a lymphedema treatment mandate in Virginia shows that costs of lymphedema treatment are an insignificant part of insured healthcare costs, and that treatment of lymphedema reduces costs of office visits and hospitalizations due to lymphedema and lymphedema-related cellulitis. Lymphedema treatment is a potent tool for reduction in healthcare costs while improving the quality of care for cancer survivors and others suffering with this chronic progressive condition.
Robert Weiss is a retired aerospace systems engineer with a BME from CCNY and an MS from UCLA. Robert retired from his 41-year employment as aerospace systems engineer and manager to learn about lymphedema and its treatment to find informed medical care for his wife Pearl, then a 5-year survivor of breast cancer with lymphedema. He found his way through the medical and insurance wilderness where lymphedema was a condition that was mostly unknown, misdiagnosed, undertreated and underinsured. Bob used the knowledge he gained to become a lymphedema patient advocate and activist and continues to provide assistance to hundreds of cancer survivors and Medicare Beneficiaries with this chronic condition. Robert has assisted in the drafting and passage of lymphedema treatment laws in California, Connecticut, Georgia, Maryland, Massachusetts, New York and Virginia and conducts research and writes on the cost-efficacy of lymphedema treatment.
