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Newswise — Reston, VA - A new Harvey L. Neiman Health Policy Institute study found that among women receiving treatment for uterine fibroids, those with Medicaid were more likely to receive uterine artery embolization (UAE) than those with commercial insurance. The research, published today in the Journal of the American College of Radiology examined the propensity for women to receive either surgical treatment (hysterectomy or myomectomy) or the less invasive UAE procedure for uterine fibroids. This study was based on 579,153 women receiving one of these three treatments and examined how treatment patterns differed by insurance type—commercial or Medicaid.

“Patients seeking treatment for uterine fibroids typically see a gynecologist for evaluation and treatment of symptoms. When medical management does not suffice, gynecologists could perform a hysterectomy or myomectomy or refer patients to an interventional radiologist to perform a UAE,” stated Dr. Pratik Shukla, MD, Associate Professor and Interventional Radiologist at Rutgers New Jersey Medical School. “Accordingly, gynecologists face a treat-or-refer decision, which ideally would not be influenced by the reimbursement the gynecologist would receive when choosing to treat rather than refer the patient.”

To examine whether reimbursement was associated with the treat-or-refer decision, the authors evaluated whether the likelihood that a women received a UAE differed by insurance type given that commercial insurance reimbursement is generally greater than Medicaid reimbursement. The analysis controlled for patient factors such as age, urbanicity, and community income level.

“We found that women with Medicaid were 38% more likely to receive UAE than those with commercial insurance” stated Dr. Eric Christensen, PhD, Research Director at the Neiman Institute. “At the same time, we found that among women who had a hysterectomy or myomectomy, women with Medicaid versus commercial insurance were 20% less likely to have the less invasive laparoscopic procedure.”

“On the surface, these results may appear conflicting; however, both are consistent with how reimbursement may influence gynecologists’ treatment decisions—both the treat-or-refer decision, and for those they choose to treat, the decision to treat with an open or laparoscopic procedure” stated Dr. Christensen. “The higher UAE rate among Medicaid patients is consistent with reimbursement incentives that is associated with gynecologists being more likely to refer Medicaid versus commercial patients. Likewise, the lower laparoscopic rate among Medicaid patients treated by gynecologists is also consistent with the notion that reimbursement incentives influence treatment patterns, given payment differences between laparoscopic open surgical procedures and between Medicaid and commercial patients.”

“While physicians may not overtly make treatment decisions based on reimbursement, reimbursement may be more influential when there are multiple specialties with treatment options,” stated Dr. Shukla. “Alternative treatment options should be discussed with patients as part of the informed consent process and a more collaborative approach between gynecologists and interventional radiologists may contribute to selection of the most optimal treatment for each patient, versus the potential that reimbursement amounts influences treatment decisions.”

To obtain a copy of the study or to arrange an interview with a spokesperson, contact Nichole Gonzalez at [email protected].

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About the Harvey L. Neiman Health Policy Institute

The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at  and follow us on ,  and .