Physicians refer lower-pay Medicaid patients to interventional radiology, operate on more lucrative commercially insured

New data indicate that certain physicians may be referring lower-pay Medicaid patients to interventional radiology while performing surgical procedures on the more lucrative commercially insured population. 

Previous research has charted disparities in the use of minimally invasive IR approaches to treat fibroids in the uterus. Experts with the Neiman Health Policy Institute sought to understand how insurance influences these care decisions, sharing their findings Wednesday in the Journal of the American College of Radiology. 

Women covered by Medicaid are about 38% likelier to undergo uterine artery embolization—an alternative to hysterectomy that involves injecting tiny particles to stop blood flow to the uterus. States with higher Medicaid reimbursement rates for hysterectomy also were associated with lower odds of receiving the less invasive UAE alternative, the analysis found. 

OB-GYN specialists are typically faced with a choice to either treat fibroids themselves or refer patients to IRs or other specialists for alternatives.

“Reimbursement may influence this treat-or-refer decision,” lead author Pratik Shukla, MD, an associate professor and IR at Rutgers New Jersey Medical School, and co-authors wrote Feb. 19. “Note that unless patients are personally aware of UAE as a treatment option, they would need to be informed about it by their gynecologist or be referred to an interventional radiologist for a consultation. For the patients gynecologists choose to treat by hysterectomy or myomectomy, reimbursement may influence the type of treatment they provide.”

Researchers gathered their information from the Inovalon Insights database spanning 2015 to 2023. The final sample included nearly 580,000 procedures—among them, embolization, hysterectomy or myomectomy (surgical removal of fibroids). Of the patients who underwent surgery, women on Medicaid were 20% less likely (than those with commercial insurance) to undergo a less invasive laparoscopic procedure. Those on Medicaid also were younger, less likely to be continuously enrolled, and commonly resided in lower-income communities. 

Shukla and co-authors believe their results demonstrate a “clear association” between reimbursement and the care patients receive. The authors emphasized the importance of greater collaboration between interventional radiologists and gynecologists to address this issue. Previous research found that a joint practice of OB-GYNs and IRs led to increased uterine artery embolization referrals and a reduction in disparities along health plan lines. 

“While physicians may not overtly make treatment decisions based on reimbursement, reimbursement may be more influential when there are multiple specialties with treatment options,” Shukla said in an announcement from the Neiman Health Policy Institute. “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 influence treatment decisions.”