Incentivizing a safe, cost-saving and evidence-based approach to hysterectomy: Bravo UnitedHealthcare

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Who is UnitedHealthcare and what did they do? Last month UnitedHealth Group Inc., one of the nation’s largest insurers, sent a letter announcing that it would require pre-authorization for any kind of hysterectomy (for benign indications) other than outpatient vaginal hysterectomy. This decision comes in the wake of considerable press coverage regarding the dangers of a device called a power morcellator, which is used in laparoscopic and robotic hysterectomy and may increase the risk of disseminated uterine cancer. However, even before the maligned morcellator, the American College of Obstetrics and Gynecology supported vaginal hysterectomy as the procedure of choice based on the published peer-reviewed evidence. Despite this recommendation, use of so-called “minimally invasive” approaches have continued to increase over time (figure).

Trends in hysterectomy approach over time. (Source: Pitter MC, Simmonds C, Seshadri-Kreaden U, Hubert HB. The Impact of Different Surgical Modalities for Hysterectomy on Satisfaction and Patient Reported Outcomes. Interact J Med Res 2014;3(3):e11)

What’s the big deal about prior authorization? There are three groups with separate interests that oppose this decision.

UnitedHealth is not restricting care; it is requiring careful consideration of the options, and justification for less safe, more costly approaches. We as providers will have to change our training and our mindset to provide the best care possible, and help our patients make more informed decisions—there is no ethically acceptable alternative.

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One Response to “Incentivizing a safe, cost-saving and evidence-based approach to hysterectomy: Bravo UnitedHealthcare”

  1. nimae15 Says:

    Great post! Very informative and the graph really illustrates the trends. Robotic assisted hysterectomy is “the new kid on the block” and as mentioned in the post the use of this technique like several new treatments in medicine can be influenced more by the market and perceptions rather than what is safer or most appropriate for the respective patient. The hyperlinks were very informative and the article from ACOG clearly outlines the outcomes and complications per surgical option chosen. Although some may view United Health’s position requiring prior authorizations as a means of cutting costs by denying potentially more expensive procedure (robotics), it also serves as a checklist allowing both provider and patient to consider viable alternatives before making this informed decision.

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