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Tarwala R, Mercuri JJ, Iorio R, Karkare N. Ethical Considerations in Total Joint Arthroplasty. J Am Acad Orthop Surg 2023; 31:1001-1008. [PMID: 37561941 DOI: 10.5435/jaaos-d-22-00941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Hip and knee arthroplasty surgeries have excellent outcomes and notably improve quality of life. However, ethical issues permeate the practice of adult reconstruction, and as economics and technology evolve, these issues have become increasingly important. This article will review the currently published literature on ethical issues including industry influences, implants and instrumentations, surgical innovation, new technology adoptions, and healthcare policy-relevant issues, including patient cost sharing and bundled care programs. In addition, the direct marketing of implants from the manufacturer to the general public may falsely raise patient expectations concerning the long-term clinical outcome and performance of newer devices in the absence of long-term studies. This article will also focus on relevant contemporary ethical issues that do not necessarily have preexisting published literature or guidelines but, nonetheless, are crucial for adult reconstruction surgeons to address. These issues include access to care and challenges with orthopaedic resident and fellow education. Surgeons must understand the ethical issues that can arise in their clinical practice and how those issues affect patients. Clinicians are tasked with making the best-reasoned judgment possible to optimize their patients' outcomes. Still, the ability to standardize treatment while optimizing individual outcomes for unique patients remains a challenge.
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Affiliation(s)
- Rupesh Tarwala
- From the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY (Tarwala), the Division of Adult Hip and Knee Reconstruction, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Scranton, PA (Mercuri), the Harvard Medical School, Brigham and Women's Hospital, Boston, MA (Iorio), and Lenox Hill Hospital, New York, NY (Karkare)
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Alokozai A, Lindsay SE, Eppler SL, Fox PM, Ladd AL, Kamal RN. Patient Willingness to Pay for Faster Return to Work or Smaller Incisions. Hand (N Y) 2021; 16:811-817. [PMID: 31791156 PMCID: PMC8647324 DOI: 10.1177/1558944719890039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Value-based health care models such as bundled payments and accountable care organizations can penalize health systems and physicians for excess costs leading to low-value care. Health systems can minimize these extra costs by constraining diagnostic (eg, magnetic resonance imaging utilization) or treatment options with debatable necessity in the setting of clinical equipoise. Instead of restricting more expensive treatments, it is plausible that health systems could instead recoup the extra costs of these treatments by charging patients supplementary out-of-pocket charges (cost sharing). The primary aim of this exploratory study was to assess hand surgery patient willingness to pay supplementary out-of-pocket charges for a procedure that theoretically leads to an earlier return to work or smaller incisions when there are 2 procedures that lead to similar results (clinical equipoise). Methods: A total of 122 patients completed a questionnaire that included demographic information, a financial distress assessment, a series of scenarios asking patients the degree to which they are willing to pay extra for the procedure choice, as well as their perspective of how much insurers should be responsible for these additional costs. Results: Patients were willing to pay out-of-pocket to some degree for a procedure that leads to earlier return to work and smaller incision size when compared with a similar alternative procedure, but noted that insurers should bear a greater burden of costs. Approximately 10% of patients were willing to pay maximum amounts ($2500+) for earlier return to work (3, 7, and 14 days earlier) and smaller incision sizes of any length. Conclusions: Some patients may be willing to pay out-of-pocket and cost share for procedures that lead to earlier return to work and smaller incisions in the setting of clinical equipoise. As such, when developing and implementing alternative payment models, health systems could potentially offer services with debatable necessity in the setting of equipoise for a supplementary out-of-pocket charge.
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Affiliation(s)
- Aaron Alokozai
- VOICES Health Policy Research Center, Stanford University Department of Orthopaedic Surgery, Redwood City, CA, USA
| | - Sarah E. Lindsay
- VOICES Health Policy Research Center, Stanford University Department of Orthopaedic Surgery, Redwood City, CA, USA
| | - Sara L. Eppler
- VOICES Health Policy Research Center, Stanford University Department of Orthopaedic Surgery, Redwood City, CA, USA
| | - Paige M. Fox
- VOICES Health Policy Research Center, Stanford University Department of Orthopaedic Surgery, Redwood City, CA, USA
| | - Amy L. Ladd
- VOICES Health Policy Research Center, Stanford University Department of Orthopaedic Surgery, Redwood City, CA, USA
| | - Robin N. Kamal
- VOICES Health Policy Research Center, Stanford University Department of Orthopaedic Surgery, Redwood City, CA, USA,Robin N. Kamal, Department of Orthopaedics, Stanford University Hospitals, 450 Broadway Street, MC6342, Redwood City, CA 94603, USA.
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Fuhrmann A, Batash R, Schwarzkopf R, Backstein D. Patient willingness to contribute to the cost of novel implants in total joint arthroplasty: the Canadian experience. Can J Surg 2019; 62:294-299. [PMID: 31550090 DOI: 10.1503/cjs.007118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background In Canada, health care is covered by provincial health insurance programs; patients do not directly participate in paying for their acute care expenses. The aim of this study is to assess the willingness of Canadian patients to contribute to the costs of novel total joint arthroplasty implants. Methods We administered a questionnaire to patients attending an outpatient arthroplasty clinic in Ontario. In the questionnaire, the longevity and risk of complications of a “standard” implant were described. We asked if participants would be willing to contribute to the cost of 3 novel implants that had differing longevities and risks of complications compared with the standard implant. Results One hundred and fifteen patients completed our questionnaire. Up to 62% of patients were willing to contribute a copayment to get an implant with greater longevity. Willingness to pay decreased to 40% for an implant with greater longevity but an increased risk of complications. Forty percent of participants were willing to pay for an implant with the same longevity as the standard implant but a decreased risk of complications. Participants with a higher income were more willing than other participants to contribute to the cost of a novel implant with greater longevity or lower complication rates. Conclusion This study demonstrated that up to 62% of our sample of patients in Ontario were willing to share the costs of a novel total joint replacement implant. Willingness to pay was associated with the proposed benefits of the implant and certain patient characteristics. Our study shows that a high proportion of Canadian patients may be willing to copay to have access to new technologies.
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Affiliation(s)
- Ariel Fuhrmann
- From the Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Fuhrmann, Backstein); the Department of Orthopedic Surgery, Barzilai Medical Centre, Ashkelon, Israel (Fuhrmann, Batash); and the Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, N.Y. (Schwarzkopf)
| | - Ron Batash
- From the Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Fuhrmann, Backstein); the Department of Orthopedic Surgery, Barzilai Medical Centre, Ashkelon, Israel (Fuhrmann, Batash); and the Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, N.Y. (Schwarzkopf)
| | - Ran Schwarzkopf
- From the Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Fuhrmann, Backstein); the Department of Orthopedic Surgery, Barzilai Medical Centre, Ashkelon, Israel (Fuhrmann, Batash); and the Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, N.Y. (Schwarzkopf)
| | - David Backstein
- From the Division of Orthopaedics, Mount Sinai Hospital, Toronto, Ont. (Fuhrmann, Backstein); the Department of Orthopedic Surgery, Barzilai Medical Centre, Ashkelon, Israel (Fuhrmann, Batash); and the Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, N.Y. (Schwarzkopf)
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Wasterlain AS, Bello RJ, Vigdorchik J, Schwarzkopf R, Long WJ. Surgeons' Perspectives on Premium Implants in Total Joint Arthroplasty. Orthopedics 2017; 40:e825-e830. [PMID: 28662250 DOI: 10.3928/01477447-20170619-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/03/2017] [Indexed: 02/03/2023]
Abstract
Declining total joint arthroplasty reimbursement and rising implant prices have led many hospitals to restrict access to newer, more expensive total joint arthroplasty implants. The authors sought to understand arthroplasty surgeons' perspectives on implants regarding innovation, product launch, costs, and cost-containment strategies including surgeon gain-sharing and patient cost-sharing. Members of the International Congress for Joint Reconstruction were surveyed regarding attitudes about implant technology and costs. Descriptive and univariate analyses were performed. A total of 126 surgeons responded from all 5 regions of the United States. Although 76.9% believed new products advance technology in orthopedics, most (66.7%) supported informing patients that new implants lack long-term clinical data and restricting new implants to a small number of investigators prior to widespread market launch. The survey revealed that 66.7% would forgo gain-sharing incentives in exchange for more freedom to choose implants. Further, 76.9% believed that patients should be allowed to pay incremental costs for "premium" implants. Surgeons who believed that premium products advance orthopedic technology were more willing to forgo gain-sharing (P=.040). Surgeons with higher surgical volume (P=.007), those who believed implant companies should be allowed to charge more for new technology (P<.001), and those who supported discussing costs with patients (P=.004) were more supportive of patient cost-sharing. Most arthroplasty surgeons believe technological innovation advances the field but support discussing the "unproven" nature of new implants with patients. Many surgeons support alternative payment models permitting surgeons and patients to retain implant selection autonomy. Most respondents prioritized patient beneficence and surgeon autonomy above personal financial gain. [Orthopedics. 2017; 40(5):e825-e830.].
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McLawhorn AS, Buller LT. Bundled Payments in Total Joint Replacement: Keeping Our Care Affordable and High in Quality. Curr Rev Musculoskelet Med 2017; 10:370-377. [PMID: 28741101 PMCID: PMC5577424 DOI: 10.1007/s12178-017-9423-6] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review was to evaluate the literature regarding bundle payment reimbursement models for total joint arthroplasty (TJA). RECENT FINDINGS From an economic standpoint, TJA are cost-effective, but they represent a substantial expense to the Centers for Medicare & Medicaid Services (CMS). Historically, fee-for-service payment models resulted in highly variable cost and quality. CMS introduced Bundled Payments for Care Improvement (BPCI) in 2012 and subsequently the Comprehensive Care for Joint Replacement (CJR) reimbursement model in 2016 to improve the value of TJA from the perspectives of both CMS and patients, by improving quality via cost control. Early results of bundled payments are promising, but preserving access to care for patients with high comorbidity burdens and those requiring more complex care is a lingering concern. Hospitals, regardless of current participation in bundled payments, should develop care pathways for TJA to maximize efficiency and patient safety.
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Affiliation(s)
- Alexander S. McLawhorn
- Adult Reconstruction & Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Leonard T. Buller
- Department of Orthopedic Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL USA
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Mercuri JJ, Bosco JA, Iorio R, Schwarzkopf R. The Ethics of Patient Cost-Sharing for Total Joint Arthroplasty Implants. J Bone Joint Surg Am 2016; 98:e111. [PMID: 28002379 DOI: 10.2106/jbjs.16.00394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- John J Mercuri
- 1Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY
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O'Hara NN, Slobogean GP, Mohammadi T, Marra CA, Vicente MR, Khakban A, McKee MD. Are patients willing to pay for total shoulder arthroplasty? Evidence from a discrete choice experiment. Can J Surg 2016; 59:107-12. [PMID: 27007091 DOI: 10.1503/cjs.011915] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is a common treatment to decrease pain and improve shoulder function in patients with severe osteoarthritis (OA). In Canada, patients requiring this procedure often wait a year or more. Our objective was to determine patient preferences related to accessing TSA, specifically comparing out-of-pocket payments for treatment, travel time to hospital, the surgeon's level of experience and wait times. METHODS We administered a discrete choice experiment among patients with endstage shoulder OA currently waiting for TSA. Respondents were presented with 14 different choice sets, each with 3 options, and they were asked to choose their preferred scenario. A conditional logit regression model was used to estimate the relative preference and willingness to pay for each attribute. RESULTS Sixty-two respondents completed the questionnaire. Three of the 4 attributes significantly influenced treatment preferences. Respondents had a strong preference for an experienced surgeon (mean 0.89 ± standard error [SE] 0.11), while reductions in travel time (-0.07 ± 0.04) or wait time (-0.04 ± 0.01) were of less importance. Respondents were found to be strongly averse (-1.44 ± 0.18) to surgical treatment by a less experienced surgeon and to paying out-of-pocket for their surgical treatment (-0.56 ± 0.05). CONCLUSION Our results suggest that patients waiting for TSA to treat severe shoulder OA have minimal willingness to pay for a reduction in wait time or travel time for surgery, yet will pay higher amounts for treatment by an experienced surgeon.
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Affiliation(s)
- Nathan N O'Hara
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Gerard P Slobogean
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Tima Mohammadi
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Carlo A Marra
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Milena R Vicente
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Amir Khakban
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Michael D McKee
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
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O'Hara NN, Slobogean GP, Mohammadi T, Marra CA, Vicente MR, Khakban A, McKee MD. Are patients willing to pay for total shoulder arthroplasty? Evidence from a discrete choice experiment. CANADIAN JOURNAL OF SURGERY. JOURNAL CANADIEN DE CHIRURGIE 2016. [PMID: 27007091 DOI: 10.1503/cjs.011915.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/26/2022]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is a common treatment to decrease pain and improve shoulder function in patients with severe osteoarthritis (OA). In Canada, patients requiring this procedure often wait a year or more. Our objective was to determine patient preferences related to accessing TSA, specifically comparing out-of-pocket payments for treatment, travel time to hospital, the surgeon's level of experience and wait times. METHODS We administered a discrete choice experiment among patients with endstage shoulder OA currently waiting for TSA. Respondents were presented with 14 different choice sets, each with 3 options, and they were asked to choose their preferred scenario. A conditional logit regression model was used to estimate the relative preference and willingness to pay for each attribute. RESULTS Sixty-two respondents completed the questionnaire. Three of the 4 attributes significantly influenced treatment preferences. Respondents had a strong preference for an experienced surgeon (mean 0.89 ± standard error [SE] 0.11), while reductions in travel time (-0.07 ± 0.04) or wait time (-0.04 ± 0.01) were of less importance. Respondents were found to be strongly averse (-1.44 ± 0.18) to surgical treatment by a less experienced surgeon and to paying out-of-pocket for their surgical treatment (-0.56 ± 0.05). CONCLUSION Our results suggest that patients waiting for TSA to treat severe shoulder OA have minimal willingness to pay for a reduction in wait time or travel time for surgery, yet will pay higher amounts for treatment by an experienced surgeon.
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Affiliation(s)
- Nathan N O'Hara
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Gerard P Slobogean
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Tima Mohammadi
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Carlo A Marra
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Milena R Vicente
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Amir Khakban
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
| | - Michael D McKee
- From the R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD (O'Hara, Slobogean); the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, St. Paul's Hospital, Vancouver, BC (Mohammadi); the School of Pharmacy, Memorial University, St. John's, NF (Marra); the Department of Orthopaedics, St. Michael's Hospital, Toronto, Ont. (Vincente, McKee); and the Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC (Khakban)
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How Much Do Patients Value Total Hip and Knee Arthroplasty? A Prospective, Multicenter Study. J Arthroplasty 2016; 31:562-6.e3. [PMID: 26631283 DOI: 10.1016/j.arth.2015.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/02/2015] [Accepted: 10/12/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With increasing health care expenditures, reform has largely focused on cost containment, particularly in elective procedures such as total hip and knee arthroplasty (THA and TKA, respectively). The primary objective of this study is to determine what financial value patients place on these highly successful procedures. METHODS An anonymous survey was administered to 670 patients at 4 different institutions (2 private practice and 2 academic centers) in the outpatient setting over a 15-month period. Patients were asked what reimbursement a surgeon should receive for a primary total joint arthroplasty (TJA), their perception of how much Medicare actually reimburses for TJA, how much they would pay out of pocket for the procedure, and their opinion of current Medicare reimbursement rates. RESULTS Of the 557 patients who participated in the survey (83% response rate), patients on average felt that orthopedic surgeons should be reimbursed $27,430 for a THA and $19,830 for a TKA. Patients would be willing to pay a significant amount of out-of-pocket costs for their procedure, mean of $14,397 for THA (50.3% of total costs) and $12,797 for TKA (46.3% of total costs). Although patients in private practice groups had higher education and household income (P < .001), patients in academic centers would be willing to pay more out-of-pocket costs ($15,922 vs $5782, P = .034 for THA, $14,419 vs $4556, P = .052 for TKA). CONCLUSION Patients in both private practice and academic centers feel that surgeons are underpaid for primary THA and TKA. As controversy continues to surround orthopedic surgeons' participation in Medicare, many patients are still willing to pay a significant amount of out-of-pocket expenses for TJA.
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Schwarzkopf R, Kahn TL. Patient risk taking and spending habits correlate with willingness to pay for novel total joint arthroplasty implants. Arthroplast Today 2015; 1:14-18. [PMID: 28326362 PMCID: PMC4926826 DOI: 10.1016/j.artd.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/09/2014] [Accepted: 12/16/2014] [Indexed: 10/25/2022] Open
Abstract
In this study, we compare patients' risk-taking and spending behaviors to their willingness to pay (WTP) for novel implants in a joint arthroplasty. 210 patients were surveyed regarding risk-taking and spending behavior, and WTP for novel implants with either increased-longevity, increased-longevity with higher risk of complications, or decreased risk of complications compared to a standard implant. Patients with increased recreational risk-taking behavior were more WTP for increased-longevity. Patients who "rarely" take health-risks were more WTP for decreased risk of complications. Patients with higher combined risk scores were more WTP for all novel implants. Patients who paid more than $50,000 for their current car were more WTP for decreased complications. This study shows that patients' risk taking and spending behavior influences their WTP for novel implants.
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Affiliation(s)
- Ran Schwarzkopf
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA, USA
| | - Timothy L Kahn
- Department of Orthopaedic Surgery, University of California, Irvine Medical Center, Orange, CA, USA
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