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Scientific article| Volume 44, ISSUE 11, P992.e1-992.e26, November 2019

Cost in Hand Surgery: The Patient Perspective

Published:February 20, 2019DOI:https://doi.org/10.1016/j.jhsa.2019.01.009

      Purpose

      Rising costs at the patient level have been recognized and shown to directly influence patient decisions. By understanding patient interests in discussing cost, hand surgeons may better prepare themselves and their practices to communicate costs with patients.

      Methods

      We surveyed 128 patients at an upper extremity surgery clinic at their 2-week postoperative visit. Survey domains included basic patient demographics and an assessment of patient financial distress, along with questions that rated patient interest with patient-physician financial conversations. These factors included patients' desire for a conversation regarding cost, whether or not patients have discussed cost with their surgeon, barriers to these discussions, and overall views concerning cost containment in hand care.

      Results

      Seven percent of patients discussed the costs of their surgical care with their physician. Eleven percent of patients reported that a doctor should not discuss the costs of their surgical care. Forty-eight percent of patients reported that a doctor should initiate a conversation regarding costs of care when a new treatment is being considered. Fifty-nine percent of patients agreed that physicians should consider the amount of money a patient will have to pay when choosing a new treatment.

      Conclusions

      Patients can experience financial hardship as a result of their surgery and some patients are interested in discussing costs with their doctor. Patients indicated that doctors should be concerned with lowering the costs of surgery and should initiate a conversation regarding costs of care when a new treatment is being considered.

      Clinical relevance

      Patients are interested in a conversation regarding their cost of hand surgery care. Making cost data more transparent and available to physicians and patients may facilitate communication regarding cost of care.

      Key words

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      References

        • Nwachukwu B.U.
        • Hamid K.S.
        • Bozic K.J.
        Measuring value in orthopaedic surgery.
        JBJS Rev. 2013; 1
        • Hamel L.
        • Norton M.
        • Pollitz K.
        • Claxton G.
        The burden of medical debt: results from the Kaiser Family Foundation/New York Times Medical Bills Survey.
        (Available at:)
        • Agenda Public
        How Much Will It Cost?.
        (Available at:)
        • Zafar S.Y.
        • Peppercorn J.M.
        • Schrag D.
        • et al.
        The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience.
        Oncologist. 2013; 18: 381-390
        • O’Hara N.N.
        • Slobogean G.P.
        • Mohammadi T.
        • et al.
        Are patients willing to pay for total shoulder arthroplasty? Evidence from a discrete choice experiment.
        Can J Surg. 2016; 59: 107-112
        • Tseng C.-W.
        • Brook R.H.
        • Keeler E.
        • Steers W.N.
        • Mangione C.M.
        Cost-lowering strategies used by Medicare beneficiaries who exceed drug benefit caps and have a gap in drug coverage.
        JAMA. 2004; 292: 952-960
        • Centers for Disease Control and Prevention
        Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March 2016.
        (Available at:)
        • Journal of the American Medical Association
        First, Do No (Financial) Harm | Complementary and Alternative Medicine.
        (Available at:)
        • Doty M.M.
        • Collins S.R.
        • Schoen C.
        • Nicholson J.L.
        How Many Are Underinsured? Trends Among U.S. Adults, 2003 and 2007.
        (Available at:)
        • Alexander G.C.
        • Casalino L.P.
        • Tseng C.-W.
        • McFadden D.
        • Meltzer D.O.
        Barriers to patient-physician communication about out-of-pocket costs.
        J Gen Intern Med. 2004; 19: 856-860
        • Agrawal S.
        • Taitsman J.
        • Cassel C.
        Educating physicians about responsible management of finite resources.
        JAMA. 2013; 309: 1115-1116
        • Altomare I.
        • Irwin B.
        • Zafar S.Y.
        • et al.
        ReCAP: Physician experience and attitudes toward addressing the cost of cancer care.
        J Oncol Pract. 2016; 12: 247-248
        • Zafar S.Y.
        • Chino F.
        • Ubel P.A.
        • et al.
        The utility of cost discussions between patients with cancer and oncologists.
        Am J Manag Care. 2015; 21: 607-615
        • Irwin B.
        • Kimmick G.
        • Altomare I.
        • et al.
        Patient experience and attitudes toward addressing the cost of breast cancer care.
        Oncologist. 2014; 19: 1135-1140
        • Hunter W.G.
        • Hesson A.
        • Davis J.K.
        • et al.
        Patient-physician discussions about costs: definitions and impact on cost conversation incidence estimates.
        BMC Health Serv Res. 2016; 16: 108
        • Bullock A.J.
        • Hofstatter E.W.
        • Yushak M.L.
        • Buss M.K.
        Understanding patients’ attitudes toward communication about the cost of cancer care.
        J Oncol Pract. 2012; 8: e50-e58
        • Prawitz A.
        • Garman E.T.
        • Sorhaindo B.
        • O’Neill B.
        • Kim J.
        • Drentea P.
        Incharge Financial Distress/Financial Well-Being Scale: Development, Administration, and Score Interpretation.
        Social Science Research Network, Rochester, NY2006
        • National Public Radio, Robert Wood Johnson Foundation
        Patient Perspectives on Health Care in the United States: A Look at Seven States & the Nation.
        (Available at:)
        • Associated Press, NORC Center for Public Affairs Research
        Finding Quality Doctors: How Americans Evaluate Provider Quality in the United States.
        (Available at:)
        • Crosson F.J.
        Change the Microenvironment: Delivery System Reform Essential to Controlling Costs. 2009.
        (Available at:)
        • Leblanc M.R.
        • Lalonde J.
        • Lalonde D.H.
        A detailed cost and efficiency analysis of performing carpal tunnel surgery in the main operating room versus the ambulatory setting in Canada.
        Hand (N Y). 2007; 2: 173-178
        • Chatterjee A.
        • McCarthy J.E.
        • Montagne S.A.
        • Leong K.
        • Kerrigan C.L.
        A cost, profit, and efficiency analysis of performing carpal tunnel surgery in the operating room versus the clinic setting in the United States.
        Ann Plast Surg. 2011; 66: 245-248
        • Bismil M.
        • Bismil Q.
        • Harding D.
        • Harris P.
        • Lamyman E.
        • Sansby L.
        Transition to total one-stop wide-awake hand surgery service-audit: a retrospective review.
        JRSM Short Rep. 2012; 3: 23
        • Rhee P.C.
        • Fischer M.M.
        • Rhee L.S.
        • McMillan H.
        • Johnson A.E.
        Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures.
        J Hand Surg Am. 2017; 42: e139-e147
        • Cassel C.K.
        • Guest J.A.
        Choosing wisely: helping physicians and patients make smart decisions about their care.
        JAMA. 2012; 307: 1801-1802
        • Shih Y.C.
        • Ganz P.A.
        • Aberle D.
        • et al.
        Delivering high-quality and affordable care throughout the cancer care continuum.
        J Clin Oncol. 2013; 31: 4151-4157
        • Alexander G.C.
        • Casalino L.P.
        • Meltzer D.O.
        Patient-physician communication about out-of-pocket costs.
        JAMA. 2003; 290: 953-958
        • Zafar S.Y.
        • Tulsky J.A.
        • Abernethy A.P.
        It’s time to have “the talk” cost communication and patient-centered care.
        Oncol (Williston Park). 2014; 28: 479-480
        • Riggs K.R.
        • Ubel P.A.
        Overcoming barriers to discussing out-of-pocket costs with patients.
        JAMA Intern Med. 2014; 174: 849-850
        • Schrag D.
        • Hanger M.
        Medical oncologists’ views on communicating with patients about chemotherapy costs: a pilot survey.
        J Clin Oncol. 2007; 25: 233-237
        • Menendez M.E.
        • van Hoorn B.T.
        • Mackert M.
        • Donovan E.E.
        • Chen N.C.
        • Ring D.
        Patients with limited health literacy ask fewer questions during office visits with hand surgeons.
        Clin Orthop. 2017; 475: 1291-1297
        • Zaidi A.A.
        • Ansari T.Z.
        • Khan A.
        The financial burden of cancer: estimates from patients undergoing cancer care in a tertiary care hospital.
        Int J Equity Health. 2012; 11: 60