Fibroid treatment options: a ten year analysis of utilization and referral patterns

PurposeTo evaluate changing patterns of surgical and endovascular treatment of fibroids over a ten year period and to analyze whether values beyond patient care can drive medical decisions related to the use of Uterine Fibroid Embolization (UFE).Materials and MethodsWe collected and analyzed the medical records of all patients at our institution between January 2003 and December 2013 (n=7659) with a discharge diagnosis of uterine fibroids who were treated with either surgery (open/laparoscopic myomectomy, open/ laparoscopic hysterectomy) or embolotherapy. This cohort was further sorted by payer into Medicaid, Medicare, private insurance, or self-paid/uninsured. We then reviewed literature on medical ethics and business ethics to offer an analysis of our results.ResultsThe percentages of patients treated with UFE, myomectomy, or hysterectomy remained constant over 10 years and evenly divided between the 3 procedures with essentially no growth in UFE (27% in 2003 vs 30% in 2013). Laparoscopic procedural use however increased markedly over the same period (2.55% to 24.75%). The percent of hysterectomy and myomectomy patients on Medicaid remained relatively constant but significantly increased for UFE (.03%% in 2003; 19% in 2013).ConclusionSince satisfaction rates for these procedures have been shown to be similar, one may expect uterine-preserving procedures such as laparoscopic myomectomy and UFE to experience similar growth. Despite UFE being a well-established alternative, gynecologists are consciously or unconsciously referring more patients with lower-paying insurance (Medicaid) to interventional radiology during the same time there was 400% growth in the number of laparoscopic myomectomy (1300% increase in overall laparoscopic procedures). Although incentives such as financial gains and self-referral are readily apparent they are rarely discussed in terms of specific examples and solutions. We believe a blend of business and clinical ethics may better encompass the values which motivate medical decisions and allow us to adjust medical education and systems to fit the values we hope to exemplify. PurposeTo evaluate changing patterns of surgical and endovascular treatment of fibroids over a ten year period and to analyze whether values beyond patient care can drive medical decisions related to the use of Uterine Fibroid Embolization (UFE). To evaluate changing patterns of surgical and endovascular treatment of fibroids over a ten year period and to analyze whether values beyond patient care can drive medical decisions related to the use of Uterine Fibroid Embolization (UFE). Materials and MethodsWe collected and analyzed the medical records of all patients at our institution between January 2003 and December 2013 (n=7659) with a discharge diagnosis of uterine fibroids who were treated with either surgery (open/laparoscopic myomectomy, open/ laparoscopic hysterectomy) or embolotherapy. This cohort was further sorted by payer into Medicaid, Medicare, private insurance, or self-paid/uninsured. We then reviewed literature on medical ethics and business ethics to offer an analysis of our results. We collected and analyzed the medical records of all patients at our institution between January 2003 and December 2013 (n=7659) with a discharge diagnosis of uterine fibroids who were treated with either surgery (open/laparoscopic myomectomy, open/ laparoscopic hysterectomy) or embolotherapy. This cohort was further sorted by payer into Medicaid, Medicare, private insurance, or self-paid/uninsured. We then reviewed literature on medical ethics and business ethics to offer an analysis of our results. ResultsThe percentages of patients treated with UFE, myomectomy, or hysterectomy remained constant over 10 years and evenly divided between the 3 procedures with essentially no growth in UFE (27% in 2003 vs 30% in 2013). Laparoscopic procedural use however increased markedly over the same period (2.55% to 24.75%). The percent of hysterectomy and myomectomy patients on Medicaid remained relatively constant but significantly increased for UFE (.03%% in 2003; 19% in 2013). The percentages of patients treated with UFE, myomectomy, or hysterectomy remained constant over 10 years and evenly divided between the 3 procedures with essentially no growth in UFE (27% in 2003 vs 30% in 2013). Laparoscopic procedural use however increased markedly over the same period (2.55% to 24.75%). The percent of hysterectomy and myomectomy patients on Medicaid remained relatively constant but significantly increased for UFE (.03%% in 2003; 19% in 2013). ConclusionSince satisfaction rates for these procedures have been shown to be similar, one may expect uterine-preserving procedures such as laparoscopic myomectomy and UFE to experience similar growth. Despite UFE being a well-established alternative, gynecologists are consciously or unconsciously referring more patients with lower-paying insurance (Medicaid) to interventional radiology during the same time there was 400% growth in the number of laparoscopic myomectomy (1300% increase in overall laparoscopic procedures). Although incentives such as financial gains and self-referral are readily apparent they are rarely discussed in terms of specific examples and solutions. We believe a blend of business and clinical ethics may better encompass the values which motivate medical decisions and allow us to adjust medical education and systems to fit the values we hope to exemplify. Since satisfaction rates for these procedures have been shown to be similar, one may expect uterine-preserving procedures such as laparoscopic myomectomy and UFE to experience similar growth. Despite UFE being a well-established alternative, gynecologists are consciously or unconsciously referring more patients with lower-paying insurance (Medicaid) to interventional radiology during the same time there was 400% growth in the number of laparoscopic myomectomy (1300% increase in overall laparoscopic procedures). Although incentives such as financial gains and self-referral are readily apparent they are rarely discussed in terms of specific examples and solutions. We believe a blend of business and clinical ethics may better encompass the values which motivate medical decisions and allow us to adjust medical education and systems to fit the values we hope to exemplify.