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Impact of Payment Models and Legislation on Gender Affirming Surgery

Award Number: F32HS028748
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS
PERIOD OF PERFORMANCE START DATE: 09/01/2021
PERIOD OF PERFORMANCE END DATE: 07/01/2023

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Impact of Payment Models and Legislation on Gender Affirming Surgery - Project Summary An estimated 1.4 million Americans identify as transgender, defined as incongruence between one’s gender and their gender assigned at birth. For many transgender people, having primary and secondary sex characteristics that align with their gender is essential to mental, emotional, and physical wellbeing as well as their ability to meaningfully engage in social roles. Gender-affirming surgery allows patients to change their primary and secondary sex characteristics through a variety of operations, including vaginoplasty, phalloplasty, gender-affirming mastectomy, breast augmentation, and facial feminization. The number of individuals seeking gender-affirming procedures has increased dramatically in recent years, with over 8,000 gender-affirming procedures performed in the United States in 2017 alone. Despite their effectiveness, gender-affirming procedures are costly, and often prohibitively expensive for most patients without insurance coverage. Fortunately, many insurance carriers provide coverage for gender- affirming procedures, but most require prior authorization processes and do not offer uniform coverage for all types of procedures. Further, coverage for these procedures varies geographically, and depends on both state and federal legislation. As such, the effects of policy and payment models on the accessibility of gender- affirming surgery remains unclear. In this two-year study, we will quantitatively and qualitatively examine the impact of legislative measures and payment models on the rates of gender-affirming surgery. We specifically aim to: 1) assess the effect of payment models on access to these operations via the patient perspective and 2) utilize claims database analysis to determine the association of the enactment of the Affordable Care Act and rates of gender-affirming surgery. Results from this mixed-methods investigation are critical to evaluating the efficacy of policy affecting gender-affirming surgery and guide future legislation. The robust methodology proposed in this study alongside the rigorous coursework through the National Clinician Scholars Program will prepare Dr. Lane for a career as a surgeon-scientist with deep expertise in the application of health services research to enhance the care of transgender individuals.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = -$25,798 )
2024	2022	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	National Research Service Awards Health Services Research Training	000	2	11/20/2023	NON-COMPETING CONTINUATION	$0
2024	2022	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	National Research Service Awards Health Services Research Training	001	2	12/18/2023	NON-COMPETING CONTINUATION	-$9,798
2024	2022	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	National Research Service Awards Health Services Research Training	002	2	7/10/2024	NON-COMPETING CONTINUATION	-$16,000
														Subtotal = -$25,798

Issue Date FY: 2022 ( Subtotal = $71,734 )
2022	2022	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	National Research Service Awards Health Services Research Training	001	2	8/17/2022	NON-COMPETING CONTINUATION	$71,734
2022	2021	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	National Research Service Awards Health Services Research Training	000	1	5/26/2022	NEW	$0
														Subtotal = $71,734

Issue Date FY: 2021 ( Subtotal = $84,562 )
2021	2021	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	National Research Service Awards Health Services Research Training	000	1	9/1/2021	NEW	$84,562
2021	2021	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	National Research Service Awards Health Services Research Training	002	1	9/20/2021	NEW	$0
2021	2021	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	National Research Service Awards Health Services Research Training	001	1	9/1/2021	NEW	$0
														Subtotal = $84,562

Grand Total All Awards = $130,498

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Impact of Payment Models and Legislation on Gender Affirming Surgery

Award Number: F32HS028748

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: FELLOWSHIP/SCHOLARSHIP/STUDENT LOANS

PERIOD OF PERFORMANCE START DATE: 09/01/2021

PERIOD OF PERFORMANCE END DATE: 07/01/2023

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