Division of Plastic and Reconstructive Surgery, Oregon Health & Science University, Portland, OR.
Division of Vascular Surgery, Oregon Health & Science University, Portland, OR.
J Am Coll Surg. 2019 Nov;229(5):479-486. doi: 10.1016/j.jamcollsurg.2019.07.002. Epub 2019 Jul 18.
Expansion of insurance coverage for gender confirmation surgery (GCS) has led to a large demand for GCS in the US. We sought to determine the financial impact of providing comprehensive GCS services at an academic medical center.
This was a cross-sectional study of patients older than 18 years who presented for GCS between January 1, 2015 and July 31, 2018 at a single academic medical center. The use of GCS services and associated work relative value units is reported. Departmental and hospital-level operating (profit) margins are reported relative to other hospital services, as well as the payer mix.
A total of 818 patients underwent 970 GCS procedures between January 2015 and July 2018. Mean (SD) age was 35.32 (12.84) years. Four hundred and ninety-three (60.3%) patients underwent a masculinizing procedure, and 325 (39.7%) had a feminizing procedure. The most commonly performed procedure was chest masculinization (n = 403). The GCS case volume grew to generate 23.8% (plastic surgery) and 17.8% (urology) of total annual departmental work relative value units, and was associated with positive operating margins after recouping new faculty hiring costs. There were positive operating margins for GCS procedures for the hospital system that compare favorably with other common procedures and admissions. Medicare and Medicaid remained the most common payer throughout the study period, but dropped from 70% in 2015 to 48% in 2018.
We found that providing GCS at our academic medical center is profitable for both the surgical department and the hospital system. This suggests such a program can be a favorable addition to academic medical centers in the US.
性别确认手术（GCS）保险覆盖范围的扩大导致美国对 GCS 的需求大幅增加。我们旨在确定在学术医疗中心提供全面 GCS 服务的财务影响。
这是一项回顾性研究，研究对象为 2015 年 1 月 1 日至 2018 年 7 月 31 日期间在一家学术医疗中心就诊的年龄超过 18 岁的 GCS 患者。报告了 GCS 服务的使用情况和相关的工作相对价值单位。报告了科室和医院级别的运营（利润）利润率，与其他医院服务以及支付方组合进行了比较。
2015 年 1 月至 2018 年 7 月期间，共有 818 名患者接受了 970 次 GCS 手术。平均（SD）年龄为 35.32（12.84）岁。493 名（60.3%）患者接受了男性化手术，325 名（39.7%）接受了女性化手术。最常进行的手术是胸部男性化（n=403）。GCS 手术量的增长产生了 23.8%（整形外科）和 17.8%（泌尿科）的部门年度总工作相对价值单位，并且在收回新教职员工招聘成本后与正运营利润率相关。对于医院系统来说，GCS 手术具有正运营利润率，并且与其他常见手术和入院相比具有优势。在整个研究期间，医疗保险和医疗补助仍然是最常见的支付方，但从 2015 年的 70%降至 2018 年的 48%。
我们发现，在我们的学术医疗中心提供 GCS 服务对手术部门和医院系统都是有利可图的。这表明这样的项目可以成为美国学术医疗中心的一个有利补充。
