Women’s Health Surgeries Reimbursed at Lower Rates, Doctors Say |
Minna Lee Jamison spent years in pain waiting for a diagnosis. When a specialist finally approved her for surgery, she was forced to wait three more years.
Lee Jamison has endometriosis, a chronic disease that occurs when tissue similar to the uterine lining grows outside of the uterus. People with endometriosis can experience extreme pain, inflammation, scarring, and even infertility.
Many people need excision surgery to remove the tissue—Lee Jamison included. But she had to battle insurance denials and long surgery waitlists, ultimately delaying her physician-recommended surgery from 2020 to 2023.
“There are already few specialist surgeons out there, and fewer surgeons that accept insurance,” Lee Jamison told Rewire News Group in an email. “I was 96th on the waitlist for a consult appointment.”
Lee Jamison is not alone. An estimated 11 percent of women of reproductive age in the U.S. suffer from endometriosis and many need surgery. But patients face exceedingly long wait times and high out-of-pocket costs. Now, gynecologic surgeons are speaking out about one factor they believe is contributing to the problem: inequitable distribution of surgical reimbursements.
I will begin my training as a resident physician soon, and after four years of medical school, I have a deep understanding of who pays for health-care in the U.S., how—and of the many flaws built into this system.
In the U.S., insurance reimbursements for surgical procedures are driven by a decades-old federal structure known as the relative value units (RVU) system. The system uses physician work, practice expenses, and malpractice insurance costs to determine physician reimbursement.
Dr. Louise P. King, a gynecological surgeon, lawyer, and Harvard Medical School professor who teaches medical ethics, has been at the forefront of identifying and studying RVU disparities.
“The RVU system was created in the 1980s through a portion of the Social Security Act,” she said. “Prior to that time, physicians would charge whatever they thought was the right amount of money.”
To ensure procedures had an objective, standard cost, researchers at the Harvard School of Public Health in 1985 designed studies to decipher how much different procedures and clinical work would be worth in RVUs.
Under the system Harvard developed, which first applied to Medicare in 1992, RVU values are assigned to the........