IR legislation

How UFE legislation success sets a precedent for URM health care

It is almost impossible to discuss health care disparities—especially among Black women—without mentioning fibroids. While over two-thirds of women will experience uterine fibroids by age 50, 60% of Black women will develop fibroids by age 35. Not only do they develop fibroids earlier, but Black women are more likely to develop fibroids more frequently, form larger ones and experience severe symptoms.1 Black women are also two to three times more likely to undergo hysterectomy and require hospitalization for fibroid treatment compared to white women.2  

IR has long acknowledged that uterine fibroid embolization (UFE) is a revolutionary therapy that can treat fibroids in a noninvasive manner that preserves the uterus and has a shorter recovery period than a hysterectomy, which is the traditional treatment.3 

The data and evidence that UFE can be a life-changing treatment for Black women is clear. But just because we’ve found a solution, doesn’t mean the problem is resolved. UFE is one of many treatments that could benefit underserved populations but often have difficulty reaching that demographic due to systemic barriers to care. Recent victories with UFE awareness have highlighted a legislative path forward to break down those barriers. 

How a need becomes a law 

Last year, new Rhode Island state legislation was passed that helped address these barriers. It says, in part,  

This act would provide health care coverage for laparoscopic removal of uterine fibroids, including uterine artery embolization, intraoperative ultrasound guidance, and monitoring and radiofrequency ablation, commencing January 1, 2023.4 

This legislation represents one of the few times that a state has passed a law directing payers to cover the cost of specific medical procedures that might otherwise be denied. For those in Rhode Island suffering with fibroids but unable to afford therapy, this act will be lifechanging. 

As of Jan. 1, 2023, private health insurance carriers, health maintenance organizations, nonprofit health medical service plans and nonprofit hospital service plans providing obstetric and gynecological care to women in Rhode Island must pay for specific fibroid treatments and procedures. 

Motivated by a desire to help women suffering from fibroids (especially low-income women of color), Rep. Camille Vella-Wilkinson, D-R.I., first introduced this bill, moving it to the floor of the Rhode Island General Assembly in early 2021. At the time, however, UFE was not included in the list of covered procedures. 

In April 2021, SIR received a call from a member expressing concern that the Rhode Island fibroid treatment legislation was rapidly making its way to becoming law, without including UFE.  

An initial phone conversation with Rep. Vella-Wilkinson revealed that she did not know about interventional radiology or IR procedures for fibroids. She wanted to learn more. A virtual meeting with several IRs introduced Rep. Vella-Wilkinson to IR and the many ways that interventional radiologists improve women’s health. At the conclusion of the meeting, Rep. Vella-Wilkinson promised to put a hold on her legislation and reintroduce the bill in 2022 with UFE in place.  

Not only was the bill reintroduced in January 2022, but Rep. Vella-Wilkinson accelerated her pace and got the bill passed by the Rhode Island Senate and General Assembly in June. SIR representatives Theresa Caridi, MD, FSIR, and John C. Lipman, MD, FSIR, joined the governor at a bill-signing ceremony on July 22 as part of the state’s recognition of Fibroid Awareness Month. 

The Rhode Island situation was an example of an extraordinary convergence of factors that rarely happens in advocacy: a passionate and persistent bill sponsor who was open to a cold call from a stranger and then willing to adjust course to ensure that interventional radiology and UFE were included. 

Navigating federal legislation 

The federal legislative process is quite another story. By design, it is lengthy, laborious and can take many years to enact legislation.  

In 2007, Rep. Stephanie Tubbs Jones, D-Ohio, introduced a bill to increase funding and awareness of fibroids. It was written with full awareness of the impact that fibroids have on women—Black women in particular. It did not pass. 

Now, more than 15 years later, SIR is working closely with Rep. Yvette Clarke (D-NY) and Sens. Corey Booker, D-N.J., and Shelley Moore Capito, R-W.V., to pass the Stephanie Tubbs Jones Uterine Fibroid Research and Education Act of 2021. H.R. 2007 would provide $150 million to the National Institutes of Health (NIH) for critical research into uterine fibroids and fund public education programs to support women suffering from fibroids.5 

Elected to Congress in 2001, Rep. Clarke was forced to miss her swearing-in ceremony because she was having a partial hysterectomy to remove her fibroid tumors. Rep. Clarke has said she regrets that she was never told at that time there were less invasive procedures available and wants to help women preserve their ability to bear children despite having fibroids. 

The uterine fibroid research and education legislation has been referred to health committees in the House of Representatives and the Senate but will expire when this session of Congress ends. The bill sponsors are persistent, and SIR will continue to advocate when the fibroid research bills are reintroduced again. 

With support, fast change is possible 

That said, Congress can still act quickly to address urgent medical situations. One example is the passage of the Dr. Lorna Breen Health Care Provider Protection Act (HR 1667), which President Biden signed into law on Feb. 24 of last year. The bill protects physicians who receive mental health assistance without jeopardizing their medical licenses and establishes grants for employee education and mental and behavioral health treatment.6 When Lorna Breen, MD, tragically committed suicide in April 2020, this legislation was rushed through Congress to address the growing problem of physician burnout. 

Support for PAD screening 

With UFE legislation experiencing success and Congress passing bills such as H.R. 1667, many see this progress as an opportunity for additional legislation aimed at improving health care access.  

For instance, The Amputation Reduction and Compassion (ARC) Act (H.R. 2631)7 was introduced to the House of Representatives in April 2021. If passed, the bill would cover screening for peripheral arterial disease (PAD) for at-risk beneficiaries through Medicare and Medicaid. PAD impacts an estimated 20 million Americans, a disproportionate number of whom are underrepresented minorities (URMs).8 Expanding coverage for PAD screening would combat serious PAD complications that lead to avoidable amputations, which an estimated 200,000 patients undergo each year. These nontraumatic amputations are also performed on racial and ethnic minorities at a disproportionately high rate.9 

H.R. 2631 would also require arterial testing before amputation is performed to determine if other interventions can be applied to salvage the limb. Additionally, the act would work to educate health care professionals and the public about PAD with the aim of increasing awareness and reducing amputations. 

Research has shown that early diagnosis and treatment can prevent as many as 85% of amputations,10 but making and keeping these services available to URMs requires extensive advocacy efforts. 

Currently, the proposed 2023 Medicare Physician Fee Schedule (MPFS) includes significant cuts to revascularization services, which would impose 5–9% cuts on payments to physicians when these services are performed in office-based labs. These services are crucial to preventing avoidable amputations in the treatment of PAD, and these cuts would likely make it harder for URMs to receive this necessary care.11  

In response, the CardioVascular Coalition (CVC) is calling on Congress and the Centers for Medicare and Medicaid Services (CMS) to address these cuts. SIR, a member of the CVC, is also working to further PAD legislation by supporting the passage of H.R. 2631 through advocacy efforts. In addition to sending letters to Congress, SIR has held meetings with Rep. Donald M. Payne, D-N.J., chair of the Congressional PAD Caucus and sponsor of H.R. 2631, and with Rep. Mike Bilirakis, R-Fla., the co-chair of the Congressional PAD Caucus. SIRPAC also donated to Mr. Payne’s and Mr. Bilirakis’s election campaigns.  

The way forward 

Advocacy is one way that health providers can pause and leave the bedside while still working to improve patient care. Virtual lobbying continues in the post-COVID advocacy world and allows busy physicians to remain in the clinical setting while adding their voices to discussions with lawmakers to improve health care and support interventional radiology. 

Please consider becoming a volunteer for the SIR Voices for IR grassroots advocacy program, which provides education and opportunities to engage with your elected officials. Your voice does matter. 

References 

  1. Mostafavi B. Understanding racial disparities for women with fibroids. University of Michigan mHealth Lab. Aug. 12, 2020. labblog.uofmhealth.org/rounds/understanding-racial-disparities-for-women-uterine-fibroids. 
  2. Wechter ME, Stewart EA, Myers ER, Kho RM, Wu JM. Leiomyoma-related hospitalization and surgery: Prevalence and predicted growth based on population trends. Am J Obstet Gynecol. 2011 Nov;205(5):492.e1–5. doi: 10.1016/j.ajog.2011.07.008. Epub 2011 Jul 20. PMID: 22035951; PMCID: PMC3746963. 
  3. The fibroid fix: What women need to know. Society of Interventional Radiology. Aug. 29, 2017. sirweb.org/globalassets/aasociety-of-interventional-radiology-home-page/patient-center/fibroid/sir_report_final.pdf. 
  4. An act relating to insurance—Accident and sickness insurance policies, RI H 5898. (2021). 
  5. Stephanie Tubbs Jones Uterine Fibroid Research and Education Act of 2021, H.R. 2007, 117th Cong. congress.gov/bill/117th-congress/house-bill/2007/text. 
  6. Dr. Lorna Breen Health Care Provider Protection Act, H.R. 1667, 117th Cong. (2021). congress.gov/bill/117th-congress/house-bill/1667. 
  7. ARC Act of 2021, H.R. 2631, 117th Cong. gov/bill/117th-congress/house-bill/2631?r=1&s=3. 
  8. Yost M. The economic cost of PAD, CLI and venous disease: How big is the market? Lecture. May 2019. 
  9. Nehler MR, Duval S, Diao L, Annex BH, Hiatt WR, Rogers K, Zakharyan A, Hirsch AT. Epidemiology of peripheral arterial disease and critical limb ischemia in an insured national population. J Vasc Surg. 2014 Sep;60(3):686–95.e2. doi: 10.1016/j.jvs.2014.03.290. Epub 2014 May 10. PMID: 24820900. 
  10. Creager M, et al. Reducing nontraumatic lower-extremity amputations by 20% by 2030: Time to get to our feet: A policy statement from the American Heart Association. Circ. 2021;143:e875–e891. 
  11. CY 2023 Final MPFS estimated impact comparative analysis of services related to interventional radiology. Society of Interventional Radiology. 2022. sirweb.org/practice-resources/coding-page.