About Hysterectomy – The PPO Role

Hysterectomy is the second most common surgical procedure performed on women, with the first being caesarian section for childbirth.  One third of women have a hysterectomy by the time they are 60 years old.  As noted in ACOG’s Policy Statement, there are a variety of reasons hysterectomies are performed.  A PPO’s first oversight responsibility is to assure that hysterectomies are being carried out for appropriate indications.  The second oversight responsibility is to assure that patients who do have hysterectomies receive surgical care consistent with guidelines and best practice recommendations.  These sources recommend that women have the least invasive procedure needed to treat the underlying condition. 

From the patient perspective, a woman first needs to have information needed to evaluate the risks and benefits of surgery against those of non-surgical alternatives. The second issue is to support women with information needed to make informed decisions about the route of hysterectomy.  With MIP and any other surgical procedure there are risks – women need to understand specific risks of each type of procedure and make an informed decision.

A PPO’s role is to make decision support information available to women to assist in making an initial decision about hysterectomy.  PPOs can also take action to close the quality gap in which women undergo open abdominal hysterectomy – a major surgical procedure, when guidelines and professional organizations recommend minimally invasive hysterectomy for the vast majority of cases.

One doctor’s mission to promote MIP

PPOs can:

• Contract with surgeons skilled in minimally invasive procedures
• Provide information to women on how to assess their surgical options
• Educate primary care practitioners on MIP to improve referral networks
• Provide incentives or financial rewards to physicians for performing minimally invasive procedures
• Identify MIP practitioners in the network and highlight their availability in the physician directory and other member communications
• Talk with payers about creating incentives in benefit design that promote minimally invasive procedures