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Endometriosis Policy

Endometriosis and adenomyosis are chronic, disabling conditions that affect millions of Americans. They can cause severe pain, fatigue, gastrointestinal dysfunction, and infertility—often interfering with a person's ability to work or attend school. Despite this, these diseases are not explicitly recognized under the Americans with Disabilities Act (ADA) or the Family and Medical Leave Act (FMLA), leaving patients without guaranteed protections, accommodations, or medical leave.

Endometriosis is a chronic, progressive disease that affects over 1 in 10 women and people assigned female at birth, often leading to debilitating pain, infertility, and organ damage. The current CMS reimbursement rates for endometriosis excision surgery—the gold-standard, evidence-based treatment—are drastically undervalued compared to the procedure's complexity, duration, and long-term effectiveness.

Excision surgery fully removes endometrial-like lesions from affected organs, providing significantly better outcomes than ablation, which merely burns tissue at the surface and has higher recurrence rates. However, because CMS codes and payment levels have not been updated to reflect the surgical expertise and time required for excision, many skilled surgeons cannot afford to offer this care within insurance networks.

This systemic underpayment limits patient access to medically necessary treatment, drives up long-term healthcare costs due to repeated ineffective surgeries, and contributes to inequities in women's health coverage. Adjusting CMS reimbursement rates is essential to ensure equitable access to life-changing, curative care for millions of patients.

The current structure of obstetrics and gynecology as a combined specialty limits the advancement of care for complex gynecologic conditions like endometriosis. While obstetrics focuses on pregnancy and childbirth, gynecology encompasses a wide range of reproductive health conditions requiring specialized surgical and diagnostic expertise. The dual focus dilutes training, research, and clinical exposure to diseases such as endometriosis—resulting in delayed diagnoses, inadequate treatment, and continued patient suffering.

Endometriosis is a chronic, whole-body inflammatory disease that often requires advanced surgical skill for effective management. Yet, most OB/GYN residency programs allocate limited time to non-obstetric gynecologic surgery, leaving many providers underprepared to identify or treat endometriosis appropriately. As a result, patients frequently endure years of misdiagnosis or undergo ineffective procedures such as ablation rather than definitive excision.

Creating distinct specialties for Obstetrics and Gynecology would allow for deeper surgical training, focused research, and evidence-based standards of care within gynecology—particularly for complex conditions like endometriosis, adenomyosis, and pelvic pain. This separation would improve patient outcomes, expand the pipeline of skilled surgeons, and modernize women's healthcare in line with the needs of today's patients.