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.
Key words
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Article info
Publication history
Published online: August 16, 2022
Accepted:
June 15,
2022
Received:
October 11,
2021
Footnotes
Dr Kamal is consultant for Acumed, Restor3d and Triple Ring and is a board member on American Academy of Orthopaedic Surgeons and American Society for Surgery of the Hand. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
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