What we are doing now
After analyzing the needs of patients and providers around the world and acknowledging the lack of national standards to improve outcomes, AAGL and CGE have launched two other ambitious programs:
- a registry of physicians that includes operative experience and complication rate, as reviewed by their peers. This system lists physicians by level of practice, according to complexity of procedures, and by proactive experience and specialization
- a center of excellence in minimally invasive gynecology. The CGE recognizes that the achievement of best-in-class surgical outcomes requires not only an expert minimally invasive gynecologic surgeon but also an integrated, multidisciplinary surgical facility with systems and procedures to maximize quality, cost-effectiveness, and safety. For example, it is the vision of AAGL President C. Y. Liu that complex endometriosis surgery will one day be performed only by competent and experienced laparoscopic surgeons in endometriosis surgery centers.
Another initiative, launched in 2009, is the American Institute of Minimally Invasive Surgery (AIMIS). This not-for-profit organization offers member surgeons and hospitals not only accreditation and recognition, but also a number of useful products and programs, including:
- education
- guidance on technology
- business development
- insurance
- marketing strategies
- financial services
- consultation in practice management.
AIMIS is not a medical society but a national institute of which surgeons and hospitals become affiliated members.
Minimally invasive approach reduces costs, too
Rising health care costs have focused attention on ways to improve quality of care and contain costs at the same time, and minimally invasive surgery has emerged as a means of doing both. A recent study of 15,404 patients compared total abdominal hysterectomy with the minimally invasive alternatives (vaginal and laparoscopic hysterectomy) and found that the latter shortened hospitalization, reduced infection, and decreased the cost by $4,000 for the vaginal approach and $2,000 for laparoscopy.4 A study of more than 11,000 patients demonstrated a 52% reduction in the rate of hospital-acquired infection when a minimally invasive approach was utilized rather than open abdominal surgery.4
Some initiatives focus on the patient as a way of increasing utilization of minimally invasive approaches. For example, in Colorado, a 6,000-member self-funded medical plan launched a value-based program for patients undergoing colectomy, cholecystectomy, hysterectomy, appendectomy, and bariatric surgery. The program educated patients about minimally invasive options and encouraged them to seek consultation with a minimally invasive surgeon. Members who chose a minimally invasive procedure saw their copayment go down significantly. In addition, any surgeon who decided to perform one of these five procedures using an open approach was required to obtain preauthorization. Referral physicians were notified of the initiative, and minimally invasive surgeons were identified on the plan’s Web site.4
After 2 years, the plan saved nearly $1 million in direct hospital and surgeon claim costs. (Indirect savings from reduced need for prescription drugs and fewer complications were not included in this estimate. Nor were the economic advantages gained from the patient’s faster return to work and increased productivity.) After only 1 year, the utilization of minimally invasive hysterectomy rose from 28% to 80%!4
In New England, a 167-store grocery chain with 9,000 employees enrolled in the company’s self-funded health plan was able to reduce costs by identifying minimally invasive surgeons and steering members to them. The company covered 80% of surgical costs if minimally invasive surgery was performed, versus 70% for open surgery. Ultimately, the company’s per capita cost was 40% lower than all available benchmarks.4
We’re at a tipping point
The time has come for gynecologic surgeons to rejoin the revolution. Although we face many challenges, from limited experience and restricted access to training opportunities to lack of patient awareness of the benefits of minimally invasive surgery, it is imperative that we utilize minimally invasive approaches as often as possible. Educational opportunities are available, and third-party payers are beginning to demand it.
I believe it is only a matter of time before minimally invasive gynecologic procedures are the norm, not the exception.
You tell me that it’s evolution…