1
|
Fabrizio GM, Cardillo C, Egol A, Rozell JC, Schwarzkopf R, Aggarwal VK. Factors influencing patient selection of orthopaedic surgeons for total hip (THA) and total knee arthroplasty (TKA). Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05314-5. [PMID: 38641682 DOI: 10.1007/s00402-024-05314-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 03/30/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The importance of identifying how patients choose their healthcare providers has grown with the prevalence of consumer-centric health insurance plans. There is currently a lack of studies exploring the factors associated with how patients select their hip and knee joint arthroplasty surgeons. The purpose of this study was to determine how patients find their arthroplasty providers and the relative importance of various arthroplasty surgeon characteristics. METHODS An electronic mail survey was sent to 3522 patients who had visited our institution for an arthroplasty surgeon office visit between August 2022 and January 2023. The survey consisted of multiple-choice questions, which aimed to inquire about the patients' referral sources for their current arthroplasty surgeon. In addition, patients were requested to rate the significance of 22 surgeon-related factors, on a scale of 1 (Not Important At All) to 5 (Very Important), in choosing their arthroplasty surgeon. RESULTS Of the 3522 patients that received the survey, 538 patients responded (15.3%). The most common referral sources were physician referral (50.2%), family/friend referral (27.7%), and self-guided research (24.5%). Of those that were referred by a physician, 54.4% of respondents were referred by another orthopaedic provider. Patients rated board certification (4.72 ± 0.65), in-network insurance status (4.66 ± 0.71), fellowship training (4.50 ± 0.81), bedside manner/personality (4.32 ± 0.86), and facility appearance (4.26 ± 0.81) as the five most important factors in picking an arthroplasty surgeon. Television (1.42 ± 0.83), print (1.50 ± 0.88), and online (1.58 ± 0.93) advertisements, along with social media presence (1.83 ± 1.08), and practice group size (2.97 ± 1.13) were rated as the five least important factors. CONCLUSION Patients are most likely to select an arthroplasty surgeon based on referral from other physicians, namely orthopedic surgeons, in addition to board certification status, in-network insurance, and fellowship training. Overall, these findings highlight the importance of physician credentials and reputation within the orthopaedic community in order to attract and retain patients.
Collapse
Affiliation(s)
- Grant M Fabrizio
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Casey Cardillo
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Alexander Egol
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17 Street, New York, NY, 10003, USA.
| |
Collapse
|
2
|
Heo K, Karzon A, Shah J, Ayeni A, Rodoni B, Erens GA, Guild GN, Premkumar A. Trends in Costs and Professional Reimbursements for Revision Total Hip and Knee Arthroplasty. J Arthroplasty 2024; 39:612-618.e1. [PMID: 37611680 DOI: 10.1016/j.arth.2023.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND With increasing numbers of revision total hip and total knee arthroplasties (rTHAs and rTKAs), understanding trends in related out-of-pocket (OOP) costs, overall costs, and provider reimbursements is critical to improve patient access to care. METHODS A large database was used to identify 92,116 patients who underwent rTHA or rTKA between 2009 and 2018. The OOP costs associated with the surgery and related inpatient care were calculated as the sum of copayment, coinsurance, and deductible payments. Professional reimbursement was calculated as total payments to the principal physician. All monetary data were adjusted to 2018 dollars. Multivariate regressions evaluated the associations between costs and procedure type, insurance type, and region of service. RESULTS From 2009 to 2018, overall costs for rTHA significantly increased by 35.0% and overall costs for rTKA significantly increased by 32.3%. The OOP costs for rTHA had no significant changes, while OOP costs for rTKA increased by 20.1%, with patients on Medicare plans having the lowest OOP costs. Professional reimbursements, when measured as a percentage of overall costs, decreased significantly by 4.4% for rTHA and 4.0% for rTKA, with the lowest reimbursements from Medicare plans. CONCLUSION From 2009 to 2018, total costs related to rTHA and rTKA significantly increased. The OOP costs significantly increased for rTKA, and professional reimbursements for both rTHA and rTKA decreased relative to total costs. Overall, these trends may combine to create greater financial burden to patients and the healthcare system, as well as further limit patients' access to revision arthroplasty care.
Collapse
Affiliation(s)
- Kevin Heo
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Anthony Karzon
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jason Shah
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ayomide Ayeni
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Bridger Rodoni
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Greg A Erens
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - George N Guild
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
3
|
Michaud JB, Zhuang T, Shapiro LM, Cohen SA, Kamal RN. Out-of-Pocket and Total Costs for Common Hand Procedures From 2008 to 2016: A Nationwide Claims Database Analysis. J Hand Surg Am 2022; 47:1057-1067. [PMID: 35985865 DOI: 10.1016/j.jhsa.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Rising patient out-of-pocket (OOP) costs and financial distress have been associated with reduced access to and delays in care. We evaluated whether OOP and total costs for common hand procedures have increased from 2008 to 2016 and identified key drivers of these costs. METHODS Using the IBM MarketScan Research Databases, we identified patients who underwent trigger finger release, open carpal tunnel release, thumb carpometacarpal joint arthroplasty, cubital tunnel release, or open treatment of distal radius fracture in the outpatient setting between 2008 and 2016. Patient OOP costs included copayment, coinsurance, and deductible payments. Costs not directly related to medical care, such as transportation and childcare costs, were not included. The overall cost was defined as the sum of the patient OOP cost and insurer reimbursements. We calculated changes in OOP and total overall costs over the study period. We also performed multivariable linear regressions to evaluate the associations between costs and procedure type, insurance type, region, and site of service. RESULTS The mean patient OOP cost increased by 55% to 71% and the total overall cost increased by 20% to 45%, depending on the procedure, between 2008 and 2016. Facility overall costs increased by 38%, whereas professional overall costs increased by 9%. Procedures performed in an office-based setting were associated with the lowest patient OOP and total overall costs, whereas high-deductible health plans were associated with the highest OOP costs. CONCLUSIONS Patient OOP and total overall costs increased for the most common hand procedures between 2008 and 2016, driven by a substantial increase in facility costs. Office-based procedures were associated with the lowest costs. CLINICAL RELEVANCE To alleviate the rising patient cost burden, hand surgeons could incorporate OOP cost considerations into shared decision-making tools, identify patients who may benefit from financial counseling, and shift procedures to an office-based setting.
Collapse
Affiliation(s)
- John B Michaud
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Thompson Zhuang
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA
| | - Samuel A Cohen
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
| |
Collapse
|
4
|
Zhuang T, Michaud JB, Shapiro LM, Baker LC, Welch JM, Kamal RN. Prevalence, Burden, and Sources of Out-of-Network Billing in Elective Hand Surgery: A National Claims Database Analysis. J Hand Surg Am 2022; 47:934-943. [PMID: 35927122 DOI: 10.1016/j.jhsa.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 04/09/2022] [Accepted: 06/01/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Surprise out-of-network (OON) bills can represent a considerable cost burden on patients. However, OON billing remains underexplored in elective, outpatient surgery procedures, which have greater latitude for patient choice. We aimed to answer the following questions: (1) What is the prevalence and magnitude of OON charges in hand surgery? (2) What are the sources of OON charges? and (3) What factors are associated with OON charges? METHODS We analyzed patient-level data from the Clinformatics Data Mart database. We identified patients undergoing carpal tunnel release, trigger finger release, wrist ganglion removal, de Quervain release, limited palmar fasciectomy, or thumb carpometacarpal arthroplasty at in-network facilities with an in-network primary surgeon. The primary outcome was the proportion of surgical episodes with at least 1 OON charge. Secondary outcomes included the magnitude of potential balance bills (portion of OON bill exclusive of the standardized payment and expected patient cost-sharing), sources of OON charges, and factors associated with OON charges. RESULTS Of 112,211 elective hand surgery episodes, 8% (9,158) had at least 1 OON charge. OON charges ranged from $1,154 (95% confidence interval, $1,018-$1,289) for wrist ganglion removal to $3,162 (95% confidence interval, $2,902-$3,423) for thumb carpometacarpal arthroplasty. In episodes with OON charges, the major sources of OON charges were anesthesiologists (75% of episodes), durable medical equipment (10% of episodes), and pathologists (9% of episodes). Site of service, geographic region, and health exchange-purchased plans were highly associated with OON charges. CONCLUSIONS Out-of-network billing can represent a substantial cost burden to patients and should be considered in perioperative decision-making in elective hand surgery. CLINICAL RELEVANCE Understanding the potential costs related to OON services during a surgical episode, and its drivers, allows surgeons to consider detailed cost discussions during perioperative decision making.
Collapse
Affiliation(s)
- Thompson Zhuang
- VOICES Health Policy Research Center, Department of Orthopedic Surgery, Stanford University, Redwood City, CA
| | - Jack B Michaud
- VOICES Health Policy Research Center, Department of Orthopedic Surgery, Stanford University, Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopedic Surgery, University of California at San Francisco, San Francisco, CA
| | - Laurence C Baker
- Department of Health Research and Policy, Stanford University, Stanford, CA
| | - Jessica M Welch
- VOICES Health Policy Research Center, Department of Orthopedic Surgery, Stanford University, Redwood City, CA
| | - Robin N Kamal
- VOICES Health Policy Research Center, Department of Orthopedic Surgery, Stanford University, Redwood City, CA.
| |
Collapse
|
5
|
Glasser JL, Patel SA, Li NY, Patel RA, Daniels AH, Antoci V. Understanding Health Economics in Joint Replacement Surgery. Orthopedics 2022; 45:e174-e182. [PMID: 35394379 DOI: 10.3928/01477447-20220401-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The number of arthroplasty procedures has been rising at a significant rate, contributing to a notable portion of the nation's health care spending. This growth has contributed to an increase in the number of health care economic studies in the field of adult reconstruction surgery. Although these articles are filled with important information, they can be difficult to understand without a background in business or economics. The goal of this review is to define the common terminology used in health care economic studies, assess their value and benefit in the context of total joint arthroplasty, and highlight shortcomings in the current literature. [Orthopedics. 2022;45(4):e174-e182.].
Collapse
|
6
|
Durand WM, Ortiz-Babilonia CD, Badin D, Wang KY, Jain A. Patient Out-of-Pocket Cost Burden With Elective Orthopaedic Surgery. J Am Acad Orthop Surg 2022; 30:669-75. [PMID: 35797680 DOI: 10.5435/JAAOS-D-22-00085] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/21/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Out-of-pocket (OOP) costs for medical and surgical care can result in substantial financial burden for patients and families. Relatively little is known regarding OOP costs for commercially insured patients receiving orthopaedic surgery. The aim of this study is to analyze the trends in OOP costs for common, elective orthopaedic surgeries performed in the hospital inpatient setting. METHODS This study used an employer-sponsored insurance claims database to analyze billing data of commercially insured patients who underwent elective orthopaedic surgery between 2014 and 2019. Patients who received single-level anterior cervical diskectomy and fusion (ACDF), single-level posterior lumbar fusion (PLF), total knee arthroplasty (TKA), and total hip arthroplasty (THA) were identified. OOP costs associated with the surgical episode were calculated as the sum of deductible payments, copayments, and coinsurance. Monetary data were adjusted to 2019 dollars. General linear regression, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests were used for analysis, as appropriate. RESULTS In total, 10,225 ACDF, 28,841 PLF, 70,815 THA, and 108,940 TKA patients were analyzed. Most patients in our study sample had preferred provider organization insurance plans (ACDF 70.3%, PLF 66.9%, THA 66.2%, and TKA 67.0%). The mean OOP costs for patients, by procedure, were as follows: ACDF $3,180 (SD = 2,495), PLF $3,166 (SD = 2,529), THA $2,884 (SD = 2,100), and TKA $2,733 (SD = 1,994). Total OOP costs increased significantly from 2014 to 2019 for all procedures (P < 0.0001). Among the insurance plans examined, patients with high-deductible health plans had the highest episodic OOP costs. The ratio of patient contribution (OOP costs) to total insurer contribution (payments from insurers to providers) was 0.07 for ACDF, 0.04 for PLF, 0.07 for THA, and 0.07 for TKA. CONCLUSION Among commercially insured patients who underwent elective spinal fusion and major lower extremity joint arthroplasty surgery, OOP costs increased from 2014 to 2019. The OOP costs for elective orthopaedic surgery represent a substantial and increasing financial burden for patients.
Collapse
|
7
|
Kallas ON, Nezami N, Singer AD, Wong P, Kokabi N, Bercu ZL, Umpierrez M, Tran A, Reimer NB, Oskouei SV, Gonzalez FM. Cooled Radiofrequency Ablation for Chronic Joint Pain Secondary to Hip and Shoulder Osteoarthritis. Radiographics 2022; 42:594-608. [PMID: 35148246 DOI: 10.1148/rg.210074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) of the shoulder and hip is a leading cause of physical disability and mental distress. Traditional nonsurgical management alone is often unable to completely address the associated chronic joint pain. Moreover, a large number of patients are not eligible for joint replacement surgery owing to comorbidities or cost. Radiofrequency ablation (RFA) of articular sensory nerve fibers can disrupt the transmission of nociceptive signals by neurolysis, thereby providing long-term pain relief. A subtype of RFA, cooled RFA (CRFA), utilizes internally cooled electrodes to generate larger ablative zones compared with standard RFA techniques. Given the complex variable innervation of large joints such as the glenohumeral and hip joints, a larger ablative treatment zone, such as that provided by CRFA, is desired to capture a greater number of afferent nociceptive fibers. The suprascapular, axillary, and lateral pectoral nerve articular sensory branches are targeted during CRFA of the glenohumeral joint. The obturator and femoral nerve articular sensory branches are targeted during CRFA of the hip. CRFA is a promising tool in the interventionalist's arsenal for management of OA-related pain and symptoms, particularly in patients who cannot undergo, have long wait times until, or have persistent pain following joint replacement surgery. An invited commentary by Tomasian is available online. ©RSNA, 2022.
Collapse
Affiliation(s)
- Omar N Kallas
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Nariman Nezami
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Adam D Singer
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Philip Wong
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Nima Kokabi
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Zachary L Bercu
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Monica Umpierrez
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Andrew Tran
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Nickolas B Reimer
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Shervin V Oskouei
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| | - Felix M Gonzalez
- From the Department of Diagnostic and Interventional Radiology (O.N.K., N.N, A.D.S., P.W., N.K., Z.L.B., M.U., F.M.G.), Emory University School of Medicine (A.T.), and Department of Orthopedic Surgery (N.B.R., S.V.O.), Emory University School of Medicine, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA 30329
| |
Collapse
|
8
|
Abstract
Background: As medical costs continue to rise, financial distress due to these costs has led to poorer health outcomes and patient cost-coping behavior. Here, we test the null hypothesis that financial distress is not associated with delay of seeking care for hand conditions. Methods: Eighty-seven new patients presenting to the hand clinic for nontraumatic conditions completed our study. Patients completed validated instruments for measuring financial distress, pain catastrophizing, and pain. Questions regarding delay of care were included. The primary outcome was self-reported delay of the current hand clinic visit. Results: Patients who experience high financial distress differed significantly from those who experience low financial distress with respect to age, race, annual household income, and employment status. Those experiencing high financial distress were more likely to report having delayed their visit to the hand clinic (57% vs 30%), higher pain catastrophizing scores (17.7 vs 7.6), and higher average pain in the preceding week (4.5 vs 2.3). After adjusting for age, sex, and pain, high financial distress (adjusted odds ratio [OR] = 4.90) and pain catastrophizing score (adjusted OR = 0.96) were found to be independent predictors of delay. Financial distress was highly associated with annual household income in a multivariable linear regression model. Conclusions: Patients with nontraumatic hand conditions who experience higher financial distress are more likely to delay their visit to the hand clinic. Within health care systems, identification of patients with high financial distress and targeted interventions (eg, social or financial services) may help prevent unnecessary delays in care.
Collapse
Affiliation(s)
| | | | | | | | | | - Robin N. Kamal
- Stanford University, Redwood City, CA, USA,Robin N. Kamal, VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street MC 6342, Redwood City, CA 94063, USA.
| |
Collapse
|
9
|
Bernstein DN, Gruber JS, Merchan N, Garcia J, Harper CM, Rozental TD. What Factors Are Associated with Increased Financial Burden and High Financial Worry For Patients Undergoing Common Hand Procedures? Clin Orthop Relat Res 2021; 479:1227-1234. [PMID: 33394757 PMCID: PMC8133202 DOI: 10.1097/corr.0000000000001616] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have examined whether orthopaedic surgery, including hand surgery, is associated with patients' financial health. We sought to understand the level of financial burden and worry for patients undergoing two common hand procedures-carpal tunnel release and open reduction and internal fixation for a distal radius fracture-as well as to determine factors associated with a higher financial burden and worry. QUESTIONS/PURPOSES In patients undergoing operative treatment for isolated carpal tunnel syndrome with carpal tunnel release or open reduction and internal fixation for a distal radius fracture, we used validated financial burden and worry questionnaires to ask: (1) What percentage of patients report some level of financial burden, and what is the median financial burden composite score? (2) What percentage of patients report some level of financial worry, and what percentage of patients report a high level of financial worry? (3) When accounting for other assessed factors, what patient- and condition-related factors are associated with financial burden? (4) When accounting for other assessed factors, what patient- and condition-related factors are associated with high financial worry? METHODS In this cross-sectional survey study, a hand and upper extremity database at a single tertiary academic medical center was reviewed for patients 18 years or older undergoing operative treatment in our hand and upper extremity division for an isolated distal radius fracture between October 2017 and October 2019. We then selected all patients undergoing carpal tunnel release during the first half of that time period (given the frequency of carpal tunnel syndrome, a 1-year period was sufficient to ensure comparable patient groups). A total of 645 patients were identified (carpal tunnel release: 60% [384 of 645 patients]; open reduction and internal fixation for a distal radius fracture: 40% [261 of 645 patients). Of the patients who underwent carpal tunnel release, 6% (24 of 384) were excluded because of associated injuries. Of the patients undergoing open reduction and internal fixation for a distal radius fracture, 4% (10 of 261) were excluded because of associated injuries. All remaining 611 patients were approached. Thirty-six percent (223 of 611; carpal tunnel release: 36% [128 of 360]; open reduction and internal fixation: 38% [95 of 251]) of patients ultimately completed two validated financial health surveys: the financial burden composite and financial worry questionnaires. Descriptive statistics were calculated to report the percentage of patients who had some level of financial burden and worry. Further, the median financial burden composite score was determined. The percentage of patients who reported a high level of financial worry was calculated. A forward stepwise regression model approach was used; thus, variables with p values < 0.10 in bivariate analysis were included in the final regression analyses to determine which patient- and condition-related factors were associated with financial burden or high financial worry, accounting for all other measured variables. RESULTS The median financial burden composite score was 0 (range 0 [lowest possible financial burden] to 6 [highest possible financial burden]), and 13% of patients (30 of 223) reported a high level of financial worry. After controlling for potentially confounding variables like age, insurance type, and self-reported race, the number of dependents (regression coefficient 0.15 [95% CI 0.008 to 0.29]; p = 0.04) was associated with higher levels of financial burden, while retired employment status (regression coefficient -1.24 [95% CI -1.88 to -0.60]; p < 0.001) was associated with lower levels of financial burden. In addition, the number of dependents (odds ratio 1.77 [95% CI 1.21 to 2.61]; p = 0.004) and unable to work or disabled employment status (OR 3.76 [95% CI 1.25 to 11.28]; p = 0.02) were associated with increased odds of high financial worry. CONCLUSION A notable number of patients undergoing operative hand care for two common conditions reported some degree of financial burden and worry. Patients at higher risk of financial burden and/or worry may benefit from increased resources during their hand care journey, including social work consultation and financial counselors. This is especially true given the association between number of dependents and work status on financial burden and high financial worry. However, future research is needed to determine the return on investment of this resource utilization on patient clinical outcomes, overall quality of life, and well-being. LEVEL OF EVIDENCE Level III, therapeutic study.
Collapse
Affiliation(s)
- David N Bernstein
- D. N. Bernstein, J. S. Gruber, N. Merchan, J. Garcia, C. M. Harper, T. D. Rozental, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | | |
Collapse
|
10
|
Bassett HK, Coller RJ, Beck J, Hummel K, Tiedt KA, Flaherty B, Tchou MJ, Kapphahn K, Walker L, Schroeder AR. Financial Difficulties in Families of Hospitalized Children. J Hosp Med 2020; 15:652-658. [PMID: 33147127 DOI: 10.12788/jhm.3500] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND High costs of hospitalization may contribute to financial difficulties for some families. OBJECTIVE To examine the prevalence of financial distress and medical financial burden in families of hospitalized children and identify factors that can predict financial difficulties. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional survey of parents of hospitalized children at six children's hospitals between October 2017 and November 2018. MAIN OUTCOMES AND MEASURES The outcomes were high financial distress and medical financial burden. Multivariable logistic regression identified predictors of each outcome. The primary predictor variable was level of chronic disease (complex chronic disease, C-CD; noncomplex chronic disease, NC-CD; no chronic disease, no-CD). RESULTS Of 644 invited participants, 526 (82%) were enrolled, with 125 (24%) experiencing high financial distress, and 160 (30%) reporting medical financial burden. Of those, 86 (54%) indicated their medical financial burden was caused by costs associated with their hospitalized child. Neither C-CD nor NC-CD were associated with high financial distress. Child-related medical financial burden was associated with both C-CD and NC-CD (adjusted odds ratio [AOR], 4.98; 95% CI, 2.41-10.29; and AOR, 2.57; 95% CI, 1.11-5.93), compared to no-CD. Although household poverty level was associated with both measures, financial difficulties occurred in all family income brackets. CONCLUSION Financial difficulties are common in families of hospitalized children. Low-income families and those who have children with chronic conditions are at particular risk; however, financial difficulties affect all subsets of the pediatric population. Hospitalization may be a prime opportunity to identify and engage families at risk for financial distress and medical financial burden.
Collapse
Affiliation(s)
- Hannah K Bassett
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ryan J Coller
- Deparment of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jimmy Beck
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Kevin Hummel
- Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Kristin A Tiedt
- Deparment of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brian Flaherty
- Division of Pediatric Critical Care, Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Michael J Tchou
- Section of Hospital Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado-Denver, Aurora, Colorado (current affiliation)
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio (affiliation where work was conducted)
| | | | - Lauren Walker
- Section of Hospital Medicine, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Alan R Schroeder
- Division of Hospital Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
- Division of Critical Care, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
11
|
Abstract
BACKGROUND Little is known about the effect of orthopaedic trauma on the financial health of patients. We hypothesized that some patients who sustain musculoskeletal trauma experience considerable financial hardship during treatment, and we also assessed for factors associated with increased personal financial burden. METHODS We surveyed 236 of 393 consecutive patients who were approached at 1 of 2 American College of Surgeons level-I trauma centers between 2016 and 2017 following the completion of treatment for a musculoskeletal injury (60% response rate). Two validated measures (financial burden composite score and dichotomized worry score) were used to assess the financial hardship that patients experienced with the injury. RESULTS There were 236 participants in the study, the mean age was 56.3 years (range, 19 to 94 years), and 48.7% of patients were male. Of the 236 patients, 97.9% had medical insurance, yet the mean financial burden composite score (and standard deviation) was 2.4 ± 2.2 (0 indicated low and 6 indicated high). In this study, 25.0% of patients had high levels of worry about financial problems that resulted from the injury. Fifty-four percent of patients used their savings to pay for their care, and 23% of patients borrowed money or took out a loan. Twenty-three percent of patients missed payment on other bills. Fifty-seven percent of patients were required to cut expenses in general. Patients with higher composite financial burden scores had a significantly increased likelihood of high financial worry (odds ratio [OR], 1.8 [95% confidence interval (CI), 1.5 to 2.2]; p < 0.001). Factors associated with increased financial hardship were high-deductible health plan insurance (coefficient, 0.3 [95% CI, 0.002 to 0.528]; p = 0.048), Medicaid insurance (coefficient, 0.6 [95% CI, 0.342 to 0.863]; p < 0.001), failure to complete high school (coefficient, 0.475 [95% CI, 0.033 to 0.918]; p = 0.035), increased number of surgical procedures (coefficient, 0.067 [95% CI, 0.005 to 0.129]; p = 0.035), and prior medical or student loans (coefficient, 0.769 [95% CI, 0.523 to 1.016]; p < 0.001). CONCLUSIONS Despite a high rate of insurance, patients with orthopaedic trauma in our study had high rates of worry and financial distress. Asking about financial hardship may help to identify those patients with a higher personal financial burden and may promote allocation of additional social support and services.
Collapse
Affiliation(s)
| | - Madeline M McGovern
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Taina Mueller
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Mitchel B Harris
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Michael J Weaver
- Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|