- Email: [email protected]
employer relationship
misinterpreted.1 Advanced statistical models (reliability adjustment) are routinely used by statisticians to remove excess noise when comparing healthcare systems (e.g. Centers for Medicare and Medicaid Services Hospital Compare rankings).2,3 The study objective was to report the variation in reported ART clinic outcomes and potential ranking misclassification between traditional (unadjusted) and reliability-adjusted statistical methods. DESIGN: Retrospective, cross-sectional data analysis of NASS-reported ART outcomes by clinic between 2009 and 2013. MATERIALS AND METHODS: We collected all clinic-level ART outcome data reported to the NASS. Clinics with less than 5 years of data were excluded. For each clinic, we determined the unadjusted incidence of live birth rate per fresh embryo transfer (ET) cycle. We employed empirical Bayes methods to produce reliability-adjusted estimates of live birth rate per fresh ET cycle for each clinic. We ranked clinics by live birth rate and determined if classification would change based on the use of reliability adjustment in statistical analysis. RESULTS: There were 458 clinics studied. The unadjusted incidence of live birth per fresh ET cycle for a clinic ranged from 0-100% (essentially 100-fold variation) with a mean of 39.7% (interquartile range [IQR] 31.347.5%). After reliability adjustment, incidence of live birth per cycle for a clinic ranged from 19-64% (3.4-fold variation) with a mean of 39.3% (IQR 34.8-44.4%). When rankings by quartile of live birth per cycle are compared between raw and reliability-adjusted statistics, 38% of clinics in the bottom quartile are misclassified using traditional incidence (i.e. they should be ranked higher than bottom quartile), while 32% of clinics in the top quartile are misclassified using traditional incidence (i.e. they should be ranked lower than the top quartile). CONCLUSIONS: Among clinics in the U.S., there is approximately a 100-fold variation in unadjusted success rates, but only a 3.4-fold variation using reliability-adjusted statistical methods. Utilization of reliability-adjustment in reporting ART clinic outcomes may lead to a more accurate estimate of quality between clinics than the present method—a benefit to both patients and providers. References: 1. National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health. Archived ART Reports and Spreadsheets. Clinic Tables and Data Dictionary 2009-2013 Data.xls. https://www.cdc.gov/art/reports/archive.html. Accessed June 17, 2015. 2. Hofer TP, Hayward RA, Greenfield S, Wagner EH, Kaplan SH, Manning WG. The unreliability of individual physician ‘‘report cards’’ for assessing the costs and quality of care of a chronic disease. JAMA 1999;281:2098-105. 3. Shahian DM, Normand SL. Comparison of ‘‘risk-adjusted’’ hospital outcomes. Circulation 2008;117:1955-63.
O-17 Monday, October 30, 2017 12:00 PM DO HEALTH INSURANCE INFERTILITY BENEFITS IMPACT THE EMPLOYEE/EMPLOYER RELATIONSHIP. B. L. Colluraa, D. Adamson.b a RESOLVE: The National Infertility Association, McLean, VA; b Palo Alto Medical Foundation Fertility Physicians of Northern California, San Jose, CA. OBJECTIVE: To determine the impact of employer provided infertility benefits on the employee/employer relationship. DESIGN: Analysis of online consumer survey. MATERIALS AND METHODS: An anonymous online 69-item survey of employees who had at least one in vitro fertilization (IVF) egg retrieval in the United States assessed how infertility benefits offered as part of employee health insurance impacted their relationship with their employer. Each of the 5 survey sections included a series of structured questions and openended feedback. Nominal and ordinal regression was used. RESULTS: Respondents were 702 (female 98.1%) who averaged 1.68 IVF cycles, 1.1 fresh embryo and 0.83 frozen/thawed embryo transfers. Health insurance covered some diagnostic tests and/or infertility treatment in 57% either through their own or spouse’s/partner’s employer. Of those with insurance, 47% reported less than half the cost of a full IVF cycle was covered. The odds ratio of an individual with insurance, compared to those without, feeling their employer: had a family friendly work environment was 1.809 (1.230 to 2.662) (Wald c2(1)¼9.053, p¼ .003); cares about their well-being
FERTILITY & STERILITYÒ
was 1.583 (1.078 to 2.326) (Wald c2(1)¼5.479, p¼ .019); and, offers health insurance benefits that meet the needs of today’s families was 3.693 (2.494 to 5.469)(Wald c2(1)¼42.560, p¼ .000). However, the odds ratio of individuals with less than 25% coverage compared to a greater percentage feeling their employer had insurance benefits that meet the needs of today’s families was 0.062 (0.027 to 0.146)(Wald c2(1) ¼ 40.477, p < .000). The odds ratio of individuals with insurance feeling their employer listens to their needs was 2.617 (1.779 to 3.849) (Wald c2(1)¼23.853, p¼ .000), and that they would recommend their employer to someone else was 1.482 (1.011 to 2.173) (Wald c2(1)¼4.061, p¼ .044). The odds that an individual with insurance took less time off work for treatment was 0.653 (.433 to .984)(Waldc2(1)¼4.141, p¼ .042). Similarly, an individual with insurance was 2.354 times (1.101 to 5.301)(Wald c2(1)¼4.877, p¼ .027) less likely than those without insurance to take off work due to psychological stress, depression, or other conditions related to their infertility. Demographics and treatment outcome did not affect findings. CONCLUSIONS: Infertile people with employer-provided health insurance covering infertility including IVF, compared to those without coverage, have higher satisfaction with their employer across many important aspects of employment. Furthermore, they are more likely to recommend their employer to a friend and, compared to those with infertility and no employer provided health insurance for infertility, take less time off work due to their infertility. Supported by: ARC Fertility, Cupertino, CA; EMD Serono, Rockland, MA; RESOLVE: The National Infertility Association, McLean, VA. O-18 Monday, October 30, 2017 12:15 PM PUBLIC ATTITUDES IN THE U.S. TOWARD INSURANCE COVERAGE FOR IVF AND THE PROVISION OF INFERTILITY SERVICES TO LOWER INCOME PATIENTS. J. R. Ho,a L. Aghajanova,b E. Mok-Lin,b J. R. Hoffman,b J. F. Smith,b C. N. Herndon.c aUSC Keck School of Medicine, Los Angeles, CA; bUniversity of California San Francisco, San Francisco, CA; cAlta Bates IVF Program, Berkeley, CA. OBJECTIVE: To assess attitudes in the U.S. general population toward provision of infertility care in lower income patients and determine what factors influence public opinion about infertility coverage. DESIGN: Cross-sectional web-based survey MATERIALS AND METHODS: Surveys regarding attitudes on infertility and provision of infertility care to lower income patients were distributed online to a nationally representative sample of U.S. residents. Unadjusted and adjusted risk ratios were calculated using multinomial logistic regression to compare those that supported, did not support, or were neutral towards insurance coverage of infertility services. Covariates for a multivariable model were chosen a priori or had significant associations with bivariate analysis using chi-square. RESULTS: A total of 1,027 of 1,138 participants completed the survey. 123 (12%) reported a history of infertility and 566 (55.1%) knew someone with infertility. 658 (64.1%) were in a relationship and 369 (35.9%) were unpartnered. 620 (60.4%) had private insurance, 275 (26.8%) had Medicare/ Medicaid, and 56 (5.5%) were uninsured. Most (741, 72.2%) did not consider infertility to be a disease. Over half (568, 55.3%) supported insurance coverage of infertility services including IVF. 189 (18.4%) did not think it should be covered. 735 (71.6%) of people thought that the prevalence and psychosocial impact of infertility were equal among lower and higher income people. 688 (67%) did not support physicians providing treatment to illegal immigrants with infertility that might result in a child with rights and benefits of U.S. citizenship. The majority of respondents with an opinion (512, 67.6%) believed that doctors should provide infertility treatments regardless of income level. Of supporters, 40.1% believed in the right to have a family regardless of income and 38.2% believed doctors had a social responsibility to provide infertility services. After adjusting for covariates, age <45, noncollege graduates, desiring more children, believing infertility was a disease, and residence in the Northeast remained significant predictors for support of insurance coverage. CONCLUSIONS: Public attitudes reveal that most people do not perceive infertility to be a disease. Viewing infertility as a disease is one of the strongest predictors of respondent support for insurance coverage for infertility services, pointing to the need for enhanced advocacy and education to the general public.
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O-17 Monday, October 30, 2017 12:00 PM DO HEALTH INSURANCE INFERTILITY BENEFITS IMPACT THE EMPLOYEE/EMPLOYER RELATIONSHIP. B. L. Colluraa, D. Adamson.b a RESOLVE: The National Infertility Association, McLean, VA; b Palo Alto Medical Foundation Fertility Physicians of Northern California, San Jose, CA. OBJECTIVE: To determine the impact of employer provided infertility benefits on the employee/employer relationship. DESIGN: Analysis of online consumer survey. MATERIALS AND METHODS: An anonymous online 69-item survey of employees who had at least one in vitro fertilization (IVF) egg retrieval in the United States assessed how infertility benefits offered as part of employee health insurance impacted their relationship with their employer. Each of the 5 survey sections included a series of structured questions and openended feedback. Nominal and ordinal regression was used. RESULTS: Respondents were 702 (female 98.1%) who averaged 1.68 IVF cycles, 1.1 fresh embryo and 0.83 frozen/thawed embryo transfers. Health insurance covered some diagnostic tests and/or infertility treatment in 57% either through their own or spouse’s/partner’s employer. Of those with insurance, 47% reported less than half the cost of a full IVF cycle was covered. The odds ratio of an individual with insurance, compared to those without, feeling their employer: had a family friendly work environment was 1.809 (1.230 to 2.662) (Wald c2(1)¼9.053, p¼ .003); cares about their well-being
FERTILITY & STERILITYÒ
was 1.583 (1.078 to 2.326) (Wald c2(1)¼5.479, p¼ .019); and, offers health insurance benefits that meet the needs of today’s families was 3.693 (2.494 to 5.469)(Wald c2(1)¼42.560, p¼ .000). However, the odds ratio of individuals with less than 25% coverage compared to a greater percentage feeling their employer had insurance benefits that meet the needs of today’s families was 0.062 (0.027 to 0.146)(Wald c2(1) ¼ 40.477, p < .000). The odds ratio of individuals with insurance feeling their employer listens to their needs was 2.617 (1.779 to 3.849) (Wald c2(1)¼23.853, p¼ .000), and that they would recommend their employer to someone else was 1.482 (1.011 to 2.173) (Wald c2(1)¼4.061, p¼ .044). The odds that an individual with insurance took less time off work for treatment was 0.653 (.433 to .984)(Waldc2(1)¼4.141, p¼ .042). Similarly, an individual with insurance was 2.354 times (1.101 to 5.301)(Wald c2(1)¼4.877, p¼ .027) less likely than those without insurance to take off work due to psychological stress, depression, or other conditions related to their infertility. Demographics and treatment outcome did not affect findings. CONCLUSIONS: Infertile people with employer-provided health insurance covering infertility including IVF, compared to those without coverage, have higher satisfaction with their employer across many important aspects of employment. Furthermore, they are more likely to recommend their employer to a friend and, compared to those with infertility and no employer provided health insurance for infertility, take less time off work due to their infertility. Supported by: ARC Fertility, Cupertino, CA; EMD Serono, Rockland, MA; RESOLVE: The National Infertility Association, McLean, VA. O-18 Monday, October 30, 2017 12:15 PM PUBLIC ATTITUDES IN THE U.S. TOWARD INSURANCE COVERAGE FOR IVF AND THE PROVISION OF INFERTILITY SERVICES TO LOWER INCOME PATIENTS. J. R. Ho,a L. Aghajanova,b E. Mok-Lin,b J. R. Hoffman,b J. F. Smith,b C. N. Herndon.c aUSC Keck School of Medicine, Los Angeles, CA; bUniversity of California San Francisco, San Francisco, CA; cAlta Bates IVF Program, Berkeley, CA. OBJECTIVE: To assess attitudes in the U.S. general population toward provision of infertility care in lower income patients and determine what factors influence public opinion about infertility coverage. DESIGN: Cross-sectional web-based survey MATERIALS AND METHODS: Surveys regarding attitudes on infertility and provision of infertility care to lower income patients were distributed online to a nationally representative sample of U.S. residents. Unadjusted and adjusted risk ratios were calculated using multinomial logistic regression to compare those that supported, did not support, or were neutral towards insurance coverage of infertility services. Covariates for a multivariable model were chosen a priori or had significant associations with bivariate analysis using chi-square. RESULTS: A total of 1,027 of 1,138 participants completed the survey. 123 (12%) reported a history of infertility and 566 (55.1%) knew someone with infertility. 658 (64.1%) were in a relationship and 369 (35.9%) were unpartnered. 620 (60.4%) had private insurance, 275 (26.8%) had Medicare/ Medicaid, and 56 (5.5%) were uninsured. Most (741, 72.2%) did not consider infertility to be a disease. Over half (568, 55.3%) supported insurance coverage of infertility services including IVF. 189 (18.4%) did not think it should be covered. 735 (71.6%) of people thought that the prevalence and psychosocial impact of infertility were equal among lower and higher income people. 688 (67%) did not support physicians providing treatment to illegal immigrants with infertility that might result in a child with rights and benefits of U.S. citizenship. The majority of respondents with an opinion (512, 67.6%) believed that doctors should provide infertility treatments regardless of income level. Of supporters, 40.1% believed in the right to have a family regardless of income and 38.2% believed doctors had a social responsibility to provide infertility services. After adjusting for covariates, age <45, noncollege graduates, desiring more children, believing infertility was a disease, and residence in the Northeast remained significant predictors for support of insurance coverage. CONCLUSIONS: Public attitudes reveal that most people do not perceive infertility to be a disease. Viewing infertility as a disease is one of the strongest predictors of respondent support for insurance coverage for infertility services, pointing to the need for enhanced advocacy and education to the general public.
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