Establishing a Comprehensive Lymphedema Program in a Rural Region

Background Comprehensive lymphedema programs (CLPs) have recently been established at several large academic medical centers. However, little has been published regarding implementation of multidisciplinary lymphedema programs serving predominantly rural and medically underserved populations. We describe our early experience developing a CLP and highlight lessons that may facilitate implementation in similar settings. Methods We performed a retrospective review of all patients referred to our CLP from November 2021 to April 2024. Patients without complete electronic medical record information were excluded. Financial analyses were limited to patients who underwent operative intervention and completed all insurance preauthorization and appeal processes. Results A total of 321 patients were referred to our CLP, of whom 190 underwent complete evaluation. Seventy-three patients (38.4%) underwent operative intervention, including 43 (58.9%) who underwent immediate lymphatic reconstruction (ILR). Among patients undergoing delayed lymphatic reconstruction (DLR), 60% underwent physiologic, and 26.7% underwent debulking procedures. The program demonstrated sustained growth throughout the study period with expansion into a multistate referral network. Insurance reimbursement remained limited, with insurers covering 29.7% of surgeon fees and total reimbursement averaging 35.7% of billed surgeon charges. Conclusions Development of a CLP serving a predominantly rural and medically underserved population region is feasible through multidisciplinary collaboration, strategic resource allocation, and adaptation to local resources. The principles described may provide a practical framework for developing sustainable comprehensive lymphedema programs and expanding access to specialized lymphedema care in similar settings.