Abstract
Despite increasing appreciation for the medical needs of transgender individuals, the organization of transgender medical care remains suboptimal. Transgender individuals report difficulty in finding providers who have adequate expertise in caring for transgender patients, a lack of provider cultural competence, health system barriers, and discrimination in healthcare settings. At Boston Medical Center (BMC), we sought to address these gaps within an existing academic medical center. In February 2016, BMC established a Center for Transgender Medicine and Surgery (CTMS) to provide a single address for patients to obtain transgender-specific services across a spectrum of healthcare needs. With the establishment of a CTMS at BMC, we were able to leverage broad transgender medical coverage across multiple specialties within an existing academic medical framework. Furthermore, the development of the CTMS resulted in our identification of multiple gaps in transgender healthcare which we could target. Large gaps in care for our institution included genital surgery, perisurgical support, adolescent care, and care coordination. Notably, most of our interventions used existing resources. We propose that this is a replicable model that should be adopted by other academic medical institutions.
Highlights
Transgender individuals have gender identities that differ from sex recorded at birth
With mainstream payers entering the equation, it became clear that a standard for most health insurance was noncoverage of all hair removal, classically considered ‘‘cosmetic.’’ The Center for Transgender Medicine and Surgery (CTMS) team needed to engage with policy makers to determine a strategy to provide coverage for the narrow instance of preoperative perineal hair removal before neovaginoplasty surgery, as the cost of this preoperative requirement could represent a significant barrier to care for some patients
Subscribed efforts included a day of transgender-related education that was open to local providers and a coordinated pelvic floor therapy in-service for area providers. This is the first report of the potential to leverage an existing medical framework to optimize medical care for transgender individuals and substantially increase access to care
Summary
Transgender individuals have gender identities that differ from sex recorded at birth (typically determined by examination of external genitalia). With mainstream payers entering the equation, it became clear that a standard for most health insurance was noncoverage of all hair removal, classically considered ‘‘cosmetic.’’ The CTMS team needed to engage with policy makers to determine a strategy to provide coverage for the narrow instance of preoperative perineal hair removal before neovaginoplasty surgery, as the cost of this preoperative requirement could represent a significant barrier to care for some patients. Integrated professional and administrative coordination proved indispensable to program development Because transgender care required coordination among multiple medical components of the institution along with numerous support services, the need for formal feedback loops swiftly became apparent. Subscribed efforts included a day of transgender-related education that was open to local providers and a coordinated pelvic floor therapy in-service for area providers
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