Whether a woman is covered by Medicare or by commercial insurance appears to influence the type of treatment she will likely undergo for uterine fibroids, researchers have reported.
A team led by Pratik Shukla, MD, of Rutgers New Jersey Medical School, Newark, NJ, found that women covered by Medicaid are 38% more likely to undergo uterine artery embolization (UAE) for fibroids than those with commercial insurance -- but that if they undergo hysterectomy or myomectomy they are 20% less likely to receive the less invasive, laparoscopic versions of these procedures.
The findings suggest that reimbursement incentives may impact whether gynecologists refer patients to interventional radiologists for UAE or perform surgical procedures themselves, the group noted.
"Superficially, these results appear conflicting; however, both are consistent with how reimbursement may influence gynecologists' treatment decisions," Shukla and colleagues wrote.
Seventy percent to 80% of women develop uterine fibroids by the age of 50, the team explained. The condition can be treated in a variety of ways, including hysterectomy and myomectomy (which can be open surgery or laparoscopic), and less invasive alternatives such as UAE, percutaneous radiofrequency ablation, and MRI-guided focused ultrasound. Women seeking treatment for fibroids first see their gynecologist -- who can perform a hysterectomy or myomectomy or refer them to an interventional radiologist for UAE. UAE is considered as effective as hysterectomy or myomectomy, is less invasive, and is cost-effective. But hysterectomy is the most common treatment for fibroids, at 75%.
Prior research has suggested that reimbursement influences referrals and that Medicaid and uninsured patients receive "less or different care than commercial patients for an array of conditions," the authors wrote. They sought to investigate the association of insurance type with type of fibroid treatment via a study of women between the ages of 30 and 59 who underwent either hysterectomy, myomectomy, or UAE for uterine fibroids between October 2015 and September 2023, culling this information from the Inovalon Insights dataset, which indicates whether individuals are covered by Medicaid or commercial insurance. The final study sample consisted of 579,153 procedures.
The team found the following:
The research underscores a need for collaboration across specialties, according to the authors.
"Collaboration between [gynecologists and interventional radiologists improves] perception of their management of fibroid patients, their relationships with collaborating colleagues, and work satisfaction," they concluded. "[Other partnerships like this] have demonstrated increased patient satisfaction and understanding of their disease process and treatment options through the establishment of multidisciplinary clinics."
The complete study can be found here.
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