How can healthcare access be improved for gynecologic oncology services despite declining Medicare reimbursement and geographic disparities?

Improving Healthcare Access for Gynecologic Oncology Services Amid Declining Medicare Reimbursement and Geographic Disparities

To improve healthcare access for gynecologic oncology services despite declining Medicare reimbursement and geographic disparities, a comprehensive strategy addressing affordability, availability, and accessibility must be implemented, with particular focus on telehealth expansion, reimbursement reform, and elimination of structural barriers that disproportionately affect racial minorities and rural populations.

Understanding the Current Disparities

The recent ASCO guideline on ovarian cancer treatment highlights significant disparities in gynecologic oncology care that affect mortality and quality of life outcomes 1:

• Geographic barriers: 36% of U.S. counties (1,125/3,143) are more than 50 miles from the nearest gynecologic oncologist, affecting approximately 14.8 million women 2
• Insurance-related barriers: Up to 40% of Medicare Advantage plans lack an in-network gynecologic oncologist, and 33% of private insurance plans do not include National Cancer Institute-accredited cancer centers 3
• Racial disparities: Black women with ovarian cancer have a significantly lower 5-year overall survival rate (49%) compared to White women (60%), partly due to reduced access to optimal treatment 1
• Rural disadvantages: Only 21% of nonmetropolitan counties have practicing oncologists, leading to worse survivorship outcomes and higher mortality rates 1

Multi-level Intervention Strategy

1. Provider-Level Solutions

• Expand outreach care models: Encourage gynecologic oncologists to provide care in underserved areas through incentive programs. Data shows that oncologists practicing in areas with fewer colleagues (0-5 other GOs within 50 miles) are more likely to provide rural/underserved care 4
• Reduce referral delays: Target education efforts toward obstetrician-gynecologists who initiate 71% of gynecologic oncology referrals to improve timely referrals 5
• Implement hybrid care models: Coordinate local and centralized cancer care services to balance specialized expertise with geographic accessibility 4

2. System-Level Solutions

• Telehealth implementation: Deploy patient-centered and culturally tailored telehealth solutions to address geographic barriers 1

  • Ensure solutions are developed with input from the patients themselves
  • Deliver telehealth through trusted intermediaries in communities
  • Address technological barriers for vulnerable populations

• Insurance reform: Address insurance-mediated disparities that prevent access to specialized care 3

  • Expand Medicare/Medicaid coverage for gynecologic oncology services
  • Require insurance plans to include adequate networks of gynecologic oncologists
  • Implement policies to reduce financial toxicity, which affects 50% of insured women during gynecologic cancer treatment

3. Policy-Level Solutions

• Reimbursement reform: Counter declining Medicare reimbursement trends with targeted increases for underserved areas
• Clinical trial access: Improve geographic distribution of gynecologic cancer clinical trials, particularly in states with high economic vulnerability and minoritized populations 6
• Guideline adherence: Promote adherence to treatment guidelines, which significantly improves survival across all racial, ethnic, and socioeconomic groups 1

Implementation Considerations

For Healthcare Systems

• Multidisciplinary care: Ensure all patients have access to multidisciplinary tumor boards, either in person or virtually
• Patient navigation: Implement patient navigation programs specifically designed to help vulnerable populations overcome barriers to care
• Data monitoring: Track disparities in care access and outcomes to identify areas needing intervention

For Individual Providers

• Shared decision-making: Engage patients in treatment decisions while acknowledging potential barriers to accessing recommended care
• Cultural competence: Develop cultural competence to better serve diverse patient populations
• Advocacy: Advocate for policy changes that improve reimbursement and reduce geographic disparities

Pitfalls and Caveats

• Telehealth limitations: While telehealth can improve access, it may actually compound disparities if not implemented with attention to internet access barriers 1
• Centralization vs. accessibility: The "center of excellence" model, where patients travel to urban centers, may improve quality but worsens geographic barriers—39% of gynecologic oncologists support this model despite its access limitations 4
• Insurance complexity: Even patients with insurance face significant barriers; having insurance does not guarantee access to specialized gynecologic oncology care 3

By addressing these disparities through a coordinated approach targeting provider practices, healthcare system design, and policy reform, we can improve access to gynecologic oncology services and ultimately reduce mortality and improve quality of life for all women with gynecologic cancers.