Current Practice and Perceptions Regarding Cost Communication in Breast Cancer Reconstruction: Survey Results of the American Society of Plastic Surgeons

Financial Toxicity in Breast Reconstruction: The Role of the Surgeon-Patient Cost-of-Care Discussion

The financial burden of breast cancer treatment and reconstruction is a significant concern for patients. Patient desire for preoperative cost-of-care counseling while navigating the reconstructive process remains unknown. A cross-sectional survey of women from the Love Research Army was conducted. An electronic survey was distributed to women over 18 years of age and at least 1 year after postmastectomy breast reconstruction. Descriptive statistics and multivariable modeling were used to determine desire for and occurrence of cost-of-care discussions, and factors associated with preference for such discussions. Secondary outcomes included the association of financial toxicity with desire for cost discussions. Among 839 women who responded, 620 women (74.1%) did not speak to their plastic surgeon and 480 (57.4%) did not speak to a staff member regarding costs of breast reconstruction. Of the 550 women who reported it would have been helpful to discuss costs, 315 (57.3%) were not engaged in a financial conversation initiated by a health care provider. A greater proportion of women who reported financial toxicity, compared to those who did not, would have preferred to discuss costs with their plastic surgeon (65.2% vs. 43.5%, p  < 0.001) or a staff member (75.5% vs. 59.3%, p  < 0.001). Among women with financial toxicity, those who had some form of insurance (private, Medicaid, Medicare, "other") were significantly more likely to prefer a cost-of-care discussion ( p  < 0.001, p  = 0.02, p  = 0.05, p  = 0.01). Financial discussions about the potential costs of breast reconstruction seldom occurred in this national cohort. Given the reported preference and unmet need for financial discussions by a majority of women, better cost transparency and communication is needed.

Rates of price disclosure associated with the surgical treatment of early-stage breast cancer one year after implementation of federal regulations

PURPOSE

Mastectomy, breast reconstruction (BR) and breast conserving therapy (BCT) are core components of the treatment paradigm for early-stage disease but are differentially associated with significant financial burdens. Given recent price transparency regulations, we sought to characterize rates of disclosure for breast cancer-related surgery, including mastectomy, BCT, and BR (oncoplastic reconstruction, implant, pedicled flap and free flap) and identify associated factors.

METHODS

For this cross-sectional analysis, cost reports were obtained from the Turquoise Health price transparency platform for all U.S. hospitals meeting national accreditation standards for breast cancer care. The Healthcare Cost Report Information System was used to collect facility-specific data. Addresses were geocoded to identify hospital referral and census regions while data from CMS was also used to identify the geographic practice cost index. We leveraged a Poisson regression model and relevant Medicare billing codes to analyze factors associated with price disclosure and the availability of an OOP price estimator.

RESULTS

Of 447 identified hospitals, 221 (49.4%) disclosed prices for mastectomy and 188 42.1%) disclosed prices for both mastectomy and some form of reconstruction including oncoplastic reduction (n = 184, 97.9%), implants (n = 187, 99.5%), pedicled flaps (n = 89, 47.3%), and free flaps (n = 81, 43.1%). Non-profit status and increased market competition were associated with price nondisclosure. 121 hospitals (27.1%) had an out-of-pocket price estimator that included at least one breast surgery.

CONCLUSIONS

Most eligible hospitals did not disclose prices for breast cancer surgery. Distinct hospital characteristics were associated with price disclosure. Breast cancer patients face persistent difficulty in accessing costs.

Rhinoplasty and YouTube: A Cross-Sectional Study to Assess the Quality, Dependability, and Reliability of Videos on Rhinoplasty

INTRODUCTION

Rhinoplasty, also referred to as a nose job or a reconstruction of the nose, is a surgical procedure that alters and reconstructs the nose for aesthetic or functional purposes. With the emergence of social media and modern internet accessibility, YouTube has gained popularity among users of all ages. Despite this, the accuracy and credibility of these videos and the information they include could be cause for concern.

AIMS

This study intends to assess the competence, quality, and dependability of the information in the videos related to "Rhinoplasty surgery" on YouTube.

METHODOLOGY

This is a cross-sectional observational study that analyzes rhinoplasty information on YouTube. A Google Forms questionnaire was used to collect the data. The Global Quality Score (GQS), reliability score, and Video Power Index (VPI) were used to assess quality and reliability, and statistical analysis was performed using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp. The inclusion criteria were videos ranging from 1 minute to 20 minutes in duration, pertinent to the topic of rhinoplasty surgery, and in either English or Hindi.

RESULTS

A total of 71 videos were analyzed, and 70 videos were included. A comparison of GQS, reliability score, and VPI based on the type of uploader was done by the Kruskal-Wallis test. The association between VPI, GQS, and reliability score with that of the uploader of the video was found to be statistically insignificant (p<0.05). Videos uploaded by healthcare organizations, news outlets, patients, or other relevant groups have the most GQS (4.5), whereas videos uploaded by hospitals have the lowest.

CONCLUSIONS

Compared to the type of uploader, videos have no statistically significant changes in quality, reliability, or video power, implying that the type of uploader does not necessarily impact the overall quality or reliability of the information presented in the investigated YouTube videos. While the majority of the videos addressed the indications of rhinoplasty and provided information about the etiology, there were gaps in discussing pre-procedural investigations and preventive measures. Due to our limitations, expanding the number of accounts used for search and increasing the number of videos might overcome the search algorithm.

Cost communication in cosmetic and reconstructive breast surgery: Public perceptions in the United States

BACKGROUND

There is a need to better understand the financial toxicity of surgery on patients. Recent data demonstrated that plastic surgeons seldom discuss out-of-pocket costs with patients. Not much is known regarding the public perceptions of out-of-pocket cost communication in reconstructive and cosmetic breast surgery.

METHODS

A cross-sectional survey was administered to adult women in the United States from November 2021 to December 2021 using Amazon Mechanical Turk. Perceptions regarding cost communication in plastic surgery were gathered. Incomplete responses were excluded. Multivariable models were used to identify predictors of responses.

RESULTS

There were 512 complete responses. Respondents had a mean age of 37.4 years. The majority strongly agreed or agreed that plastic surgeons should discuss out-of-pocket costs with patients undergoing implant-based breast reconstruction (85%), plastic surgeons should know the impact of surgery on patients' financial well-being (78%), and discussing costs was the most important aspect of the appointment (70%). Respondents who were unsure of their insurance status had lower odds of strongly agreeing or agreeing that surgeons should discuss out-of-pocket costs for autologous reconstruction (OR 0.12, CI 0.02-0.58, p = 0.01) and cosmetic breast augmentation (OR 0.14, CI 0.03-0.65, p = 0.01). Privately insured respondents had greater odds of strongly agreeing or agreeing to both, respectively (OR 2.21, CI 1.32-3.82, p < 0.01; OR 1.94, CI 1.17-3.31, p = 0.01) CONCLUSION: Many laywomen support the cost communication in plastic surgery and believe that plastic surgeons should know the impact of surgery on the patients' financial well-being, with variability among the sociodemographic groups. Plastic surgeons should strongly consider discussing costs with patients undergoing breast surgery.

Guideline Awareness Disparities in Plastic Surgery: A Survey of American Society of Plastic Surgeons

The American Society of Plastic Surgeons (ASPS) clinical practice guidelines were constructed to help direct evidence-based surgical management in plastic surgery. Societal member awareness of the recommendations for breast reconstruction has yet to be studied among ASPS members.

Perceived financial decline related to breast reconstruction following mastectomy in a diverse population-based cohort

BACKGROUND

Despite mandated insurance coverage for breast reconstruction following mastectomy, health care costs are increasingly passed on to women through cost-sharing arrangements and high-deductible health plans. In this population-based study, the authors assessed perceived financial and employment declines related to breast reconstruction following mastectomy.

METHODS

Women with early-stage breast cancer (stages 0-II) diagnosed between July 2013 and May 2015 who underwent mastectomy were identified through the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles and were surveyed. Primary outcome measures included patients' appraisal of their financial and employment status after cancer treatment. Multivariable models evaluated the association between breast reconstruction and primary outcomes.

RESULTS

Among 883 patients with breast cancer who underwent mastectomy, 44.2% did not undergo breast reconstruction, and 55.8% underwent reconstruction. Overall, 21.9% of the cohort reported being worse off financially since their diagnosis (25.8% with reconstruction vs 16.6% without reconstruction; P = .002). Women who underwent reconstruction reported higher out-of-pocket medical expenses (32.1% vs 15.6% with expenses greater than $5000; P < .001). Reconstruction was independently associated with a perceived decline in financial status (odds ratio, 1.92; 95% confidence interval, 1.15-3.22; P = .013). Among women who were employed at the time of their diagnosis, there was no association between reconstruction and a perceived decline in employment status (P = .927).

CONCLUSIONS

In this diverse cohort of women who underwent mastectomy, those who elected to undergo reconstruction experienced higher out-of-pocket medical expenses and self-reported financial decline. Patients, providers, and policymakers should be aware of the potential financial implications related to reconstruction despite mandatory insurance coverage.

Exploring provider- and practice-level drivers of cost-consciousness in breast cancer reconstruction-secondary analysis of a survey of the American Society of Plastic Surgeons

BACKGROUND

The role of physicians in dampening health care costs is a renewed focus of policy-makers. We examined provider- and practice-level factors affecting four domains of cost-consciousness among plastic surgeons performing breast reconstruction.

METHODS

Secondary analysis was performed on the survey responses of 329 surgeons who routinely performed breast reconstruction. Using a 5-point Likert scale, we queried four domains of cost-consciousness: out-of-pocket cost awareness, cost discussions, cognizance of patients' financial burden, and attitudes regarding cost discussions. Multivariable linear regression was performed to identify provider- and practice-level factors affecting these domains according to composite scores.

RESULTS

Overall cost-consciousness scores (CS) were moderate and ranged from 2.14 to 4.30. There were no significant differences across practice settings. Male gender (p = 0.048), Hispanic ethnicity (p = 0.021), and increasing clinical experience (p = 0.015) were associated with higher out-of-pocket cost awareness. Increasing surgeon experience was also associated with having cost discussions (p = 0.039). No provider- or practice-level factors were associated with cognizance of patients' financial burden. Salaried physicians displayed a more positive attitude toward out-of-pocket cost discussions (p = 0.049). On pairwise testing, the out-of-pocket cost awareness was significantly different between Hispanic surgeons and white surgeons (4.30 vs. 3.55), and between surgeons with more than 20 years' experience and with less than 5 years' experience (3.87 vs. 3.37).

CONCLUSIONS

Surgeon gender, ethnicity, and experience and practice compensation type inform various domains of cost-consciousness in breast reconstruction. Structural and behavioral interventions could possibly increase physicians' cost-consciousness.