WOMENS-HEALTH Messages for August, 1999: Re: FIBROID TUMORS-Followup Question From Dr. Hill's Response

Re: FIBROID TUMORS-Followup Question From Dr. Hill's Response

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Fri, 20 Aug 1999 16:01:56 -0500 (CDT)

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At Fri, 20 Aug 1999, Linda wrote:

> If I must have the fibroids removed, I have discovered a process called
>"uterine tumor embolization" which cuts off blood supply to fibroids and
>they shrink.
>Both GYN's didn't know anything about it because it's a radiological
>procedure and they
>won't make any money off of it if I choose this route.

Sorry, ma'am, I can't let this one go unchallenged. The reason your doctors don't know much about this is likely because it's a new procedure. Medical textbooks are full of horror stories of new procedures that at first glance sounded great, but later turned out to be unhelpful or even dangerous. This appears to be a reasonable procedure for some women with fibroids, but there are an increasing number of case reports of women having this procedure, getting pregnant, then having their uterus rupture, which can kill the baby. Many women who have UAE report a significant amount of pain from the procedure. This may turn out to be an excellent procedure for fibroids, but at this time I'm withholding judgement until there are more data.

With an H, they make around $25,000 in this region so I've been told. >So I understand why they're pushing organ removal.
>Women have to remember medical care is a business and if GYN's don't do
>surgery, they
>can't stay in business so naturally they're going to push the procedure
>that brings in the most
>revenue.

The actual reimbursement for hysterectomy is now at a level near that in the 1960s. HMOs are dropping the fees for this service every year. The actual fee for a hysterectomy in our area (Orlando, FL) is about $1800-$2000, which covers preop evaluation, the surgery itself, postoperative hospital rounds, and the first 6 weeks of postoperative office visits. It has never been $25,000 anywhere in the United States. I suspect you are accidentally quoting the *total* cost, including hospital room charges, medication, gynecologist's fees, and anesthesia costs. Even so, it's around $10,000-12,000 in most areas of the country.

Finally, contrary to your post (and popular Internet belief), most gynecologists make more money *not* doing surgery than doing it. Reimbursement has dropped for surgical procedures to the point where many doctors actually break even when they consider the time spent away from the office and the malpractice costs of doing surgery. For that reason, I know many gyns who almost refuse to do surgery anymore. It's not worth it to them. The ethical ones refer their patients to someone who does surgery, while the unethical ones "push" non-surgical treatment. My partners and I do a tremendous amount of gynecologic surgery, and constantly battle the HMOs to pay us a fair amount for the expertise and experience necessary to do the procedures. Sadly, many HMOs now refuse to pay for a surgical assistant during complicated laparoscopy. Yet, here is a minimally-invasive procedure that may take 2-4 hours, requires significant skill and equipment, and allows the patient to go home hours later. The patient benefits (back home with family and job within days, not weeks or months, and tiny scars), the insurance company benefits (less than 1/2 the cost of open surgery), but the doctor gets paid much less than if he opened the patient up and did the case the "usual" way. If he or she needs an assistant because of the complexity, the assistant has to beg the HMO to pay a few hundred dollars for the 4 hours he or she is in the OR. The DJ I hired for our office party gets more than that per hour!

Finally, capitated plans actually penalize doctors for offering hospitalization or surgery, because you are paid a flat fee for every patient. Any additional expense, such as hospitalization or surgery, comes out of your pocket. It's a racket most doctors hate, because it goes against the usual concept of getting paid for the work you do. Fortunately, we do not participate in this type of system.

The main goal of your post, to suggest alternatives to hysterectomy, is a great idea. However, please take care in the future to not disseminate false information.

Best wishes,

-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://home.mpinet.net/dahmd

The above is intended for general medical education, and is not for specific medical advice. I apologize, but I am unable to answer personal e-mail due to time constraints.

Next message: D. Ashley Hill, M.D.: "Re: painful intercourse"
Previous message: Lisa: "endometrial biopsy"
In reply to: Linda: "Re: FIBROID TUMORS-Followup Question From Dr. Hill's Response"
Next in thread: EMM.: "Re: FIBROID TUMORS-Followup Question From Dr. Hill's Response"
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