Uterine fibroid centers for medicare and medicaid services

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Ninety percent of women with the four surgical procedures for benign uterine fibroids were aged years in both the hospital-based ambulatory surgery and inpatient settings. A majority of the four surgical procedures for benign uterine fibroids were hysterectomies. In , hysterectomy constituted more than three-fourths of the inpatient surgeries and two-thirds of the hospital-based ambulatory surgery visits for benign uterine fibroids involving the four surgical procedures Myomectomy represented approximately 22 percent of surgeries in both the inpatient and ambulatory surgery settings.

Uterine fibroid embolization and endometrial ablation were a higher proportion of the four surgical procedures in the ambulatory surgery setting than in the inpatient setting uterine fibroid embolization: 6. Trends in four surgical procedures to treat benign uterine fibroids in hospital inpatient compared with hospital-based ambulatory surgery settings, Figures 1 and 2 present the rate of discharges per , females in the population, aged years, who had a hysterectomy, myomectomy, uterine fibroid embolization, or endometrial ablation to treat benign uterine fibroids in the hospital inpatient setting compared with the hospital-based ambulatory surgery setting, from through Figure 1 is a line graph that shows the rate of hysterectomy and myomectomy to treat benign uterine fibroids in females aged years in inpatient surgery and ambulatory surgery hospital settings in 13 States from through The rate of hysterectomy per , population in the inpatient surgery hospital setting declined steadily from The rate of hysterectomy per , population in the ambulatory surgery hospital setting increased steadily from The rate of myomectomy per , population in the inpatient surgery hospital setting declined from The rate of myomectomy per , population in the ambulatory surgery hospital setting declined steadily from Between and , the rates of hysterectomy and myomectomy decreased in the hospital inpatient setting; the rate of hysterectomy increased in the hospital-based ambulatory surgery setting.

Overall, the population rate of hysterectomy for benign uterine fibroids decreased 20 percent between and , from This decrease was driven by a 52 percent decrease in the rate of hysterectomy in the hospital inpatient setting, from At the same time, the rate of hysterectomy increased percent in the hospital-based ambulatory surgery setting, from The rate of myomectomy also decreased 29 percent in the inpatient setting from Figure 2 is a line graph that shows the rate of uterine fibroid embolization and endometrial ablation to treat benign uterine fibroids in females aged years in inpatient surgery and ambulatory surgery hospital settings in 13 States from through The rate of uterine fibroid embolization per , population in the inpatient hospital setting increased from 0.

The rate of uterine fibroid embolization per , population in the ambulatory surgery hospital setting increased from 2.

The rate of endometrial ablation per , population in the inpatient hospital setting increased from 0. The rate of endometrial ablation per , population in the ambulatory surgery setting declined from 5. Between and , the rate of uterine fibroid embolization increased in the hospital inpatient and ambulatory surgery settings; the rate of endometrial ablation decreased in both settings.

Overall, the rates of uterine fibroid embolization and endometrial ablation were much lower than the rates of hysterectomy and myomectomy Figure 1. Between and , the rate of uterine fibroid embolization increased approximately percent in both the hospital inpatient and ambulatory surgery settings inpatient: from 0. The rate of endometrial ablation decreased in both settings during this same time period inpatient: 40 percent decrease, from 0. Figure 3 presents the distribution of hospital inpatient stays compared with hospital-based ambulatory surgery visits for four surgical procedures and procedures types —hysterectomy open, vaginal, and laparoscopic , myomectomy open and laparoscopic , uterine fibroid embolization, and endometrial ablation—to treat benign uterine fibroids in Figure 3 is a bar chart that shows the distribution of surgical procedures to treat benign uterine fibroids in inpatient surgery and ambulatory surgery settings in 13 States in Of 15, open hysterectomies performed, Of 1, vaginal hysterectomies performed, Of 18, laparoscopic hysterectomies performed, Of 9, open myomectomies performed, Of 1, laparoscopic myomectomies performed, 7.

Of 1, uterine fibroid embolizations performed, Of 1, endometrial ablations performed, 1. Most open hysterectomy and myomectomy procedures were performed in the hospital inpatient setting, whereas most laparoscopic hysterectomy and myomectomy procedures were performed in the hospital-based ambulatory surgery setting.

In , nearly all open hysterectomies In contrast, laparoscopic or vaginal procedures occurred more commonly in the hospital-based ambulatory surgery setting laparoscopic hysterectomy: Uterine fibroid embolization and endometrial ablation were performed primarily in the hospital-based ambulatory surgery setting Four surgical procedures to treat benign uterine fibroids by demographic characteristics and setting, Figures 4 and 5 present the distribution of hospital inpatient stays and hospital-based ambulatory surgery visits for three of the four procedures—hysterectomy, myomectomy, and uterine fibroid embolization—to treat benign uterine fibroids in Endometrial ablation is not presented because very few of these procedures overall were performed in the inpatient setting.

Among White women who underwent a hysterectomy in , Among Black women who underwent a hysterectomy in , Among Hispanic women who underwent a hysterectomy in , Among White women who underwent a myomectomy in , Among Black women who underwent a myomectomy in , Among Hispanic women who underwent a myomectomy in , Among White women who underwent a uterine fibroid embolization in , Among Black women who underwent a uterine fibroid embolization in , Among Hispanic women who underwent a uterine fibroid embolization in , White women more commonly had hysterectomy and myomectomy in the hospital-based ambulatory surgery setting, whereas Black and Hispanic women more commonly had inpatient surgery for these procedures.

In , White women more commonly had hysterectomy and myomectomy for benign uterine fibroids in the hospital-based ambulatory surgery setting than in the inpatient setting hysterectomy: In contrast, it was more common for Black and Hispanic women to have these procedures performed in the hospital inpatient setting.

Figure 5 presents the distribution of hospital inpatient stays compared with hospital-based ambulatory surgery visits by expected primary payer for three surgical procedures to treat benign uterine fibroids in Figure 5 is a bar chart that shows the distribution of hospital setting for hysterectomy, myomectomy, and uterine fibroid embolization to treat benign uterine fibroids by expected primary payer in 13 States in Among patients covered by Medicaid who underwent a hysterectomy in , Among patients covered by private insurance who underwent a hysterectomy in , Among uninsured patients who underwent a hysterectomy in , Among patients with other insurance coverage who underwent a hysterectomy in , Among patients covered by Medicaid who underwent a myomectomy in , Among patients covered by private insurance who underwent a myomectomy in , Among uninsured patients who underwent a myomectomy in , Among patients covered by Medicaid who underwent a uterine fibroid embolization in , Among patients covered by private insurance who underwent a uterine fibroid embolization in , Among uninsured patients who underwent a uterine fibroid embolization in , Among patients with other insurance coverage who underwent a uterine fibroid embolization in , Women covered by Medicaid and uninsured women more commonly had hysterectomy and myomectomy in the hospital inpatient setting, whereas privately insured women had outpatient surgery about as often as inpatient surgery for these two procedures.

In , it was more common for women covered by Medicaid to have hysterectomy and myomectomy for benign uterine fibroids in the hospital inpatient setting than in the ambulatory surgery setting hysterectomy: Uninsured women also more commonly had inpatient stays than ambulatory surgery visits for hysterectomy In contrast, privately insured women had these two procedures performed in the ambulatory surgery setting about as often as in the inpatient setting.

Although uterine fibroid embolization was more commonly performed in the ambulatory surgery setting across payers, it was less common among women covered by Medicaid Analysis was limited to hospitals within the 13 States that had cases of benign uterine fibroids involving four surgical procedures in the inpatient and ambulatory surgery settings in each data year. Supplemental sources included population denominator data for use with HCUP databases, derived from information available from the Nielsen Company.

Secondary diagnoses are concomitant conditions that coexist at the time of the visit or admission or that develop during the stay. All-listed procedures include all procedures performed during the hospital inpatient stay or outpatient visit, whether for definitive treatment or for diagnostic or exploratory purposes. The first-listed procedure is the procedure that is listed first on the discharge record. Inpatient data define this as the principal procedure —the procedure that is performed for definitive treatment rather than for diagnostic or exploratory purposes i.

ICDCM assigns numeric codes to diagnoses and procedures. CPT assigns numeric codes to procedures. There are approximately 9, CPT procedure codes. Case definition Hospital discharge and ambulatory surgery visit records with uterine fibroids were identified based on any of the following principal ICDCM diagnosis codes: The population used in this Statistical Brief was females aged years.

Uterine fibroids become more common as women age but shrink after menopause; they are most common among women in their 40s and early 50s. These surgical procedures are the most common surgical treatments for benign uterine fibroids.

Procedures were ranked hierarchically, as shown in Table 3, so that each hospital discharge or ambulatory surgery visit record was identified with only one type of procedure. Types of hospitals included in HCUP State Inpatient Databases This analysis used State Inpatient Databases SID limited to data from community hospitals, which are defined as short-term, non-Federal, general, and other hospitals, excluding hospital units of other institutions e.

Community hospitals include obstetrics and gynecology, otolaryngology, orthopedic, cancer, pediatric, public, and academic medical hospitals. Excluded for this analysis are long-term care facilities such as rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals.

However, if a patient received long-term care, rehabilitation, or treatment for psychiatric or chemical dependency conditions in a community hospital, the discharge record for that stay was included in the analysis.

The analysis was limited to hospitals that had at least one uterine fibroid procedure performed in both the SID and SASD in each data year. Although some SASD include data from facilities not owned by a hospital, those facilities were excluded from this analysis.

The designation of a facility as hospital-owned is specific to its financial relationship with a hospital that provides inpatient care and is not related to its physical location. Ambulatory surgery performed in hospital-owned facilities may be performed within the hospital, in a facility attached to the hospital, or in a facility physically separated from the hospital.

The analysis was further limited to ambulatory surgeries performed at facilities owned by community hospitals. Community hospitals are defined as short-term, non-Federal, general, and other specialty hospitals, excluding hospital units of other institutions e.

Unit of analysis The unit of analysis is the hospital discharge i. This means that a person who is admitted to the hospital to have surgery multiple times in 1 year will be counted each time as a separate discharge from the hospital or visit.

Charges Charges represent what the hospital billed for the discharge. Hospital charges reflect the amount the hospital charged for the entire hospital stay and do not include professional physician fees. We report hospital charges rather than costs because Cost-to-Charge Ratios are not available for ambulatory surgery data. Median community-level income Median community-level income is the median household income of the patient's ZIP Code of residence.

Income levels are separated into population-based quartiles with cut-offs determined using ZIP Code demographic data obtained from the Nielsen Company. Patients in the first quartile are designated as having low income, and patients in the upper three quartiles are designated as having not low income.

The income quartile is missing for patients who are homeless or foreign. Additionally, 50 percent of women return to normal activities the next day.

The overall impact of treatment with Sonata was significant for these women, with 97 percent of women at 12 months indicating they would recommend the procedure, and women in the study experiencing durable symptom relief over at least three years.

This development will also provide benefits to payers, given that the ASC is a lower cost of care setting compared to the hospital outpatient setting. The Sonata System uses radiofrequency energy to ablate fibroids under real time sonography guidance from within the uterine cavity, utilizing the first and only intrauterine ultrasound transducer.

The System includes a proprietary graphical user interface SMART Guide , enabling the operator to target fibroids and optimize treatment. The Sonata system provides incision-free transcervical access for a uterus-preserving fibroid treatment.

This intrauterine approach is designed to avoid the peritoneal cavity. Gynesonics has developed the Sonata System for diagnostic intrauterine imaging and transcervical treatment of symptomatic uterine fibroids. Gynesonics headquarters is in Redwood City, CA. For more information, go to www. David Gutierrez, Dresner Corporate Services, dgutierrez dresnerco. This website uses cookies so that we can provide you with the best user experience possible.

Cookie information is stored in your browser and performs functions such as recognising you when you return to our website and helping our team to understand which sections of the website you find most interesting and useful. Strictly Necessary Cookie should be enabled at all times so that we can save your preferences for cookie settings. If you disable this cookie, we will not be able to save your preferences.

This means that every time you visit this website you will need to enable or disable cookies again. This website uses analytics to collect anonymous information such as the number of visitors to the site, and the most popular pages. Johnson, B. Lopez, E. About Sonata System The Sonata System uses radiofrequency energy to ablate fibroids under real time sonography guidance from within the uterine cavity, utilizing the first and only intrauterine ultrasound transducer.

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