Increasing access to in-office hysteroscopy for patients with public insurance at an academic medical center

Abstract

In-office hysteroscopy allows for treatment of certain uterine pathology without general anesthesia or an operating room, and there is growing evidence that it is a cost effective procedure associated with higher patient satisfaction and faster recovery when compared to hospital based hysteroscopy. Access to this procedure can be limited by type of insurance, public or private, and upwards of 50% of those with Medicaid in New York State identify as Black or Latinx. Our department’s Anti-Racism Task Force identified this issue as an area for intervention to reduce disparities of care. The objective of this initiative was to identify barriers to in-office hysteroscopy for patients with public insurance in order to create a workflow for publicly insured patients to access this subspecialty based procedure. In a review of in-office hysteroscopic procedures at our institution, over the last 3 years, in-office hysteroscopy has been utilized on average 2-3 times per week on patients with private health insurance. Prior to our intervention, no patients with public insurance had an in-office hysteroscopic procedure, despite similar reimbursements with prior authorization. Barriers to in-office hysteroscopy that were identified included a lack of equipment in the publicly insured office, a lack of trained proceduralists, and limited education amongst providers as to which patients are candidates for in-office hysteroscopy. After identifying these barriers, a workflow guide was created using current guidelines proposed by ACOG and AAGL to identify patients who are candidates for office hysteroscopy and connect them to trained proceduralists. In this streamlined workflow, patients identified as candidates were directly referred to an MIS Fellow and subspecialty coordinator to facilitate scheduling and prior authorization. The workflow is shown in Figure 1. The initiative was implemented on March 1, 2021, and in the first three months, there have been 22 new referrals of patients with public insurance for in-office hysteroscopy. In conclusion, this initiative demonstrates the feasibility of creating a process to identify candidates for in-office hysteroscopy with public health insurance and refer them to subspecialists. This reduces access-based healthcare disparities, with added benefits of lowering healthcare costs and improving patient satisfaction.