Business models and provider satisfaction in in-vitro fertilization centers in the United States

Abstract

The costs of treatment has been identified as the greatest barrier to infertility care in the United States. The average cost for an in-vitro fertilization (IVF) cycle in 2006 in the United States was $13,048 (1). The high cost has led to disparities in health care and access. As of 2015, 15 states have enacted legislative mandates that cover fertility services to varying degrees (2). There are different business models for cost appropriation in states with and without state mandated insurance. Details regarding the different types of business models have not been previously described. The purpose of this study was to assess the utilization of different business models, physician satisfaction and barriers to care. A national online survey was sent via email to 736 certified reproductive endocrinology and infertility physicians with membership in the Society for Reproductive Endocrinology and Infertility (SREI). The survey included 30 questions designed to assess demographics, practice patterns and business models utilized. The survey was initially sent in May 2017 and closed to enrollment in August 2017. A total of 222 respondents participated in the survey for a response rate of 30%. The majority of physicians offer a-la-carte (67.1%), bundled packages (69.4%), grants (57.1%) and cost sharing (50%). Clinics utilizing bundled packages, cost-sharing and grants perform more fresh IVF cycles and frozen embryo transfers per year than those that are not utilizing these packages. The majority believe that the ideal business model is bundled packages (52.7%). There was no overall significant association between financial package offered and region of practice or state mandated insurance. The largest barrier to care reported was cost with or without state-mandated coverage (93.9% and 99.3%, respectively). The majority of practices are satisfied with their business model (74.8%). Higher physician satisfaction was associated with private practice [69% versus 27%, P<0.001;OR (95%CI) = 3.8 (1.7,8.6)], male sex [58.5% versus 29.5%, P=0.001; OR=2.4 (1.1,5.4)], and offering bundled services [82.5% versus 59.1%, P=0.003; OR=2.8 (1.2,6.7)]. Physicians utilize a variety of business models and most are satisfied with their current model. Higher physician satisfaction was associated with private practice, male sex, and offering bundled services. Larger-volume clinics utilize statistically more bundled packages, cost-sharing and grants. Cost is the major barrier to care in both states with and without mandated coverage.