Utilizing Geographic Information Systems to Identify Access to Minimally Invasive Gynecology Surgeons for Patients With Medicaid Insurance

INTRODUCTION: Minimally invasive hysterectomy (MIH) is the gold standard for benign hysterectomy. Patients with Medicaid insurance have been shown to have decreased rates of MIH compared to patients with private insurance. The Minimally Invasive Gynecologic Surgery Fellowship (FMIGS) through AAGL has graduated over 600 fellows. However, their practice location in relationship to Medicaid enrollees is unknown. OBJECTIVE: To discover the number of Medicaid enrollees who had a hysterectomy in 2018, and their distance to the closest FMIGS-trained surgeon. Secondary objectives included the relationship between distance from an FMIGS-trained surgeon and the likelihood a patient had a MIH. METHODS: We determined all practice locations of FMIGS graduates from 2002 to 2017. We identified hysterectomies in 2018 in the CMS Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) using CPT codes. Those who had hysterectomy for cancer, or at time of cesarean section, were excluded. Patient demographic data and ICD-10 codes were collected and the first 3-digits of zip codes analyzed. Direct and road work distances to the closest FMIGS surgeon were calculated using ArcGIS (ERSI, Redlands, CA). Patients were divided into quartiles by distance, and then, rates of MIH and open hysterectomy were compared. Analytic statistics were performed. RESULTS: The analysis included 328 surgeons in 265 zip codes, and 67,375 hysterectomies in 49 states and one district. The distance from a Medicaid enrollee to an FMIGS surgeon ranged from <1 mile to 1,581 miles. Quartiles were: <16, 16–<55, 55–<101, and >101 miles (Figure 1). The overall rate of MIH was 78% vs 22% open. Farther distance from FMIGS surgeons was positively associated with likelihood for MIH (Table 1). Non-White race was associated with a lower likelihood for MIH (Table 1). CONCLUSIONS: The overall rate for MIH for Medicaid subscribers was high. Geographic proximity to FMIGS surgeons was not sufficient to increase the likelihood that Medicaid enrollees received MIH. Non-White Medicaid enrollees were less likely to receive MIH, despite having the same insurance. Most FMIGS surgeons were in urban areas, which is typically associated with higher rates of MIH. Future studies should investigate FMIGS-trained surgeons’ acceptance of Medicaid patients.