Table 3.

Proposed Approaches to Improve Payment Structures, Improve or Increase Insurance Coverage for Gynecologic Care, and Expand or Enhance the Gynecologic Workforce

Author (Year)	Focus of article	Approach	Approach description or focus
Approaches to improve payment structures
Society of Gynecologic Oncology (2013)41	Strategies to increase GO care	Implement reimbursement policies that discourage receipt of ovarian cancer care from non-specialized health care providers	Reimbursement policies should be changed to discourage providers who do not have specialty training in gynecologic oncology from providing care to women with gynecologic cancer.
		Implement reimbursement policies that encourage multidisciplinary care	Reimbursement policies should reward optimization of the care team process. The team captain should be compensated for coordinating the care required for women with gynecologic cancer. Care by ancillary service providers should be appropriately valued and compensated.
		Develop and test new physician payment methods	There is no difference in compensation when care is provided by specialists with the best training and most experience in gynecologic cancer in comparison to when that care is provided by those who do not have specialized training in gynecologic cancer. There is also limited reimbursement for coordination of care, adherence to management guidelines, meeting benchmarks on meaningful quality parameters, and achieving good patient satisfaction. New physician payment methods should be developed and tested to ensure that women with gynecologic cancer are provided the highest quality, well-coordinated care.
Approaches to improve/increase insurance coverage for gynecologic care
Duska (2018)17	Geographic availability of GOs; geographic use of GOs; factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Allow GOs to appeal insurance claim denials	Other subspecialties are allowed to appeal coverage denials. Allowing GOs to appeal coverage denials may help improve insurance coverage for gynecologic care.
University of Colorado (2019)40	Strategies to increase receipt of care from GO	Include coverage for travel expenses for patients who must travel to receive gynecological cancer treatment	Insurance plans could start subsidizing travel costs for gynecological cancer treatment.
Approaches to expand or enhance the gynecologic workforce
Canadian Partnership Against Cancer (2018)39	Strategies to increase GO care	Expanding fellowship training programs	Make a concerted effort to expand fellowship training programs to include the gynecologic oncology specialty.
Cass et al. (2016)45	Strategies to increase GO care	Promoting the gynecologic oncology specialty within medical schools and residency programs through career guidance and mentorship by senior GOs	Encourage medical schools and residency programs to focus specifically on promotion of the gynecologic oncology specialty through mentorship and career guidance within their programs as an approach to increasing the volume of GOs within the United States. These activities can help to minimize stress and burnout within the field.
Collins et al. (2014)18	Factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Expanding fellowship training programs	Train a more diverse oncology workforce; enhance educational efforts and awareness of racial and ethnic disparities.
Minig et al. (2015)28	Facilitators/barriers to GO access; strategies to increase GO care	Expanding fellowship training programs	Expand fellowship training programs worldwide.
National Academies of Sciences, Engineering, and Medicine (2016)10	Factors associated with GO use/non-use; facilitators/barriers to GO access; strategies to increase GO care	Use of academic detailing	Academic detailing is peer-to-peer educational outreach; traditionally, its goal is to improve clinical practice in a targeted area, usually one involving patient care. Academic detailing can be used to increase the number of physicians who specialize in gynecologic oncology.
Ovarian Cancer Research Alliance (n.d.)46	Strategies to increase GO care	Utilize survivors in teaching students	Bring ovarian cancer survivors and caregivers into medical education programs to educate future health care providers about ovarian cancer by sharing stories of diagnosis, treatment, and survivorship, along with facts about the disease.
Society of Gynecologic Oncology (2013)41	Strategies to increase GO care	Reviewing/revising hospital credentialing policies	Change hospital credentialing policies to discourage providers who do not have specialty training in GO from providing care to women with gynecologic cancer.

GO, gynecologist oncologist.