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Hospitals are building gender affirmation health programs. Here's how to decide which services to offer.

February 5, 2019

    Editor's note: This blog, which originally ran on The Growth Channel, was updated on May 14, 2019.

    The American Society of Plastic Surgeons reported performing 155% more gender affirming surgeries in 2017 than in 2016. It's no surprise, then, that we've been getting many questions about how to build a program that meets the needs of transgender patients in the community. To find out, we interviewed providers across the country.

    Study shows rise in sex-reassignment surgeries in the US

    In our research, we identified two keys to success that top programs all offer:

    • Administrative referral navigation and care pathway support; and
    • A sensitive, welcoming care environment.

    Surprisingly, all of these top providers were also able to offer strong gender affirmation health programs without making additional investments in technology or space. The critical difference between these programs, however, is whether they primarily focus on just surgical services, or comprehensive services.

    Here, we've laid out some key considerations of both models to help you decide which option works best for your organization.

    Surgery-focused model

    Overview: A surgery-focused program offers only transition-related surgeries, often in an à la carte style menu of services. They may partner with community resources for behavioral health care, case management, and peer-support groups. These programs typically offer in-house insurance navigation to ensure patients are prepared for surgery from a pre-authorization standpoint.

    Staffing: Surgery-focused programs can hire full- or part-time surgeons dedicated to performing transition-related surgeries. These programs often include urologists, gynecologists, and plastic surgeons, while behavioral health providers and endocrinologists more commonly partner with the program to provide pre-surgical care. Additionally, one of these physicians is typically assigned as a medical director, who is usually a surgeon who performs transition-related surgeries.

    Is this model right for you? Consider this model if your organization is a community hospital or is not affiliated with a system or AMC. While this model is primarily hospital-centric, a variation of this model is the destination approach, which is commonly utilized by private physician practices. Part of the success of this model depends on surgeons' reputations, and the ability of the program to build word-of-mouth referrals—in other words, you need to make the program a destination for those seeking transition-related surgeries.

    Comprehensive care-focused model

    Overview: The comprehensive approach provides all care that transgender patients may require, regardless of whether the service is transition-related. This is a full-spectrum of care approach that offers medical and surgical specialty services such as endocrinology, cardiovascular, orthopedics, infectious disease, etc. These programs may also offer peer-support groups, insurance navigation, and full-time program coordinators or social workers to serve as general patient navigators to help onboard and guide patients through the entire care pathway.

    Staffing: These programs are typically staffed with full- or part-time specialists such as urologists, gynecologists, plastic surgeons, primary care providers, and other non-transition related specialists. This model may also use a dyad leadership model, with a medical director and an administrative program director. Leadership in this model may be more administrative-focused in nature, compared with a surgery-focused model.

    Is this model right for you? Consider this option if your organization is an AMC or part of a system, and already offers a full spectrum of comprehensive care services. Send out an organization-wide email gauging interest, and rely on administrative support to schedule appointments along with regular caseloads to integrate the program. Create a clear entry point with a separate phone number and email address to route interested consumers directly to a program administrator.

    Learning how to decide

    Start by examining the services your organization already offers and determining what components might be missing. For example, many organizations have surgeons who are already performing transition-related surgeries or providing clinical services like hormone therapy. Then evaluate interest in participation in the program from medical staff in particular, and from leadership to ensure executive support. These initial considerations will help inform your decision about which program model might work best for your organization.


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