Changes In Health Care Policy Research Articles

A widening longevity gap between people with schizophrenia and general population: A literature review and call for action

Individuals with schizophrenia have higher mortality rates than the population at large. General mortality rates have declined in developed countries since the early 1970s, extending average lifespan by nearly a decade. This review of eight longitudinal studies of mortality in schizophrenia found that the mean standardized mortality ratio (SMR, a measure of mortality rate in schizophrenia compared to the general population) increased 37%, from 2.2 in the pre-1970s studies to 3.0 in the post-1970s reports. Major changes in societal stigma, healthcare, and economic policy are urgently warranted to ensure that this vulnerable segment of the population participates in the longevity revolution.

Factors Associated With the Trend of Physical and Chemical Restraint Use Among Long-Term Care Facility Residents in Hong Kong: Data From an 11-Year Observational Study

BackgroundNegative effects of restraint use have been well-documented. However, the prevalence of restraints use has been high in long-term care facilities in Hong Kong compared with other countries and this goes against the basic principles of ethical and compassionate care for older people. The present study aimed to review the change in the prevalence of physical and chemical restraint use in long-term care facilities (LTCFs) over a period of 11 years in Hong Kong and to identify the major factors associated with their use. MethodsThis is an observational study with data obtained from the Hong Kong Longitudinal Study on LTCF Residents between 2005 and 2015. Trained assessors (nurses, social workers, and therapists) used the Minimum Data Set Resident Assessment Instrument to collect the data from 10 residential LTCFs. Physical restraint was defined as the use of any of the following: full bedside rails on all open sides of bed, other types of bedside rails used, trunk restraint, limb restraint, or the use of chair to prevent rising during the past 7 days. Chemical restraint was defined as the use of any of the following medications: antipsychotic, antianxiety, or hypnotic agents during past 7 days, excluding elder residents with a diagnosis of psychiatric illness. OutcomesAnnual prevalence of restraint use over 11 years and factors that were associated with the use of physical and chemical restraints. ResultsWe analyzed the data for 2896 older people (978 male individuals, mean age = 83.3 years). Between 2005 and 2015, the prevalence of restraint use was as follows: physical restraint use increased from 52.7% to 70.2%; chemical restraint use increased from 15.9% to 21.78%; and either physical or chemical restraint use increased from 57.9% to 75.7%. Physical restraint use was independently associated with older age, impaired activities of daily living or cognitive function, bowel and bladder incontinence, dementia, and negative mood. Chemical restraint use was independently associated with older age, falls, bladder incontinence, use of feeding tube, dementia, poor cognitive function, delirium, behavioral problems, and negative mood. The increasing time-trend of physical but not chemical restraint use remained significant after adjusting for other factors as mentioned above (coefficient = 0.092, P < .001). ConclusionsUse of physical and chemical restraint was highly prevalent among LTCF residents in Hong Kong, with an increasing trend over a period of 11 years, especially targeting the most physically and cognitively frail older people. Appropriate healthcare staff education and policy change are urgently needed to ensure personal care that is characterized by respect, dignity, empathy, and compassion for the older generation.

Physician Shortage in Canada: A Review of Contributing Factors

The physician shortage in Canada is multifactorial. It is important to identify potential factors and policies contributing to the problem. An extensive literature review to retrieve primary source articles was performed using the PubMed database. Other sources of information included reports identified using the websites of organizations, associations, government bodies and Google scholar, as well as additional primary source articles identified using reference lists of retrieved articles and reports. Healthcare policy changes in the 1990’s limited the growth of physician supply through the reduction of medical school enrolment, restrictions on recruitment of international medical graduates into the workforce, redistribution of family physician and specialist mix and loss of physicians to the US. Inadequate supply of primary care physicians is reflected in the low interest among medical students in a family medicine career and the shortage of physicians in rural areas. Reduction of physician productivity is characterized by an aging physician population, greater proportion of women in the workforce and the reduction of direct patient care hours among the new generation of physicians. The problem is further exacerbated by inefficiencies in healthcare expenditures, judging from high healthcare spending and low physician-to-population ratio. An understanding of factors contributing to the physician shortage is essential in order to develop successful strategies to alleviate inadequate physician supply.

Digital Health Technologies to Promote Lifestyle Change and Adherence.

Cardiovascular disease is the leading cause of morbidity and mortality worldwide with an estimated 17.5 million deaths annually, or 31% of all global deaths, according to the World Health Organization. The majority of these deaths are preventable by addressing lifestyle modification (i.e., smoking cessation, diet, obesity, and physical inactivity) and promoting medication adherence. At present, initiatives to develop cost-effective modalities to support self-management, lifestyle modification, and medication adherence are a leading priority. Digital health has rapidly emerged as technology with the potential to address this gap in cardiovascular disease self-management and transform the way healthcare has been traditionally delivered. However, limited evidence exists about the type of technologies available and how they differ in functionality, effectiveness, and application. We aimed to review the most important and relevant recent studies addressing health technologies to promote lifestyle change and medication adherence including text messaging, applications ("apps"), and wearable devices. The current literature indicates that digital health technologies will likely play a prominent role in future cardiovascular disease management, risk reduction, and delivery of care in both resource-rich and resource-limited settings. However, there is limited large-scale evidence to support adoption of existing interventions. Further clinical research and healthcare policy change are needed to move the promise of new digital health technologies towards reality.

Disparities in access to breast cancer treatment: An observational study based on insurance status.

6534 Background: Breast cancer is the second leading cause of cancer death in Caucasians and African-Americans, and the most common cause of cancer death in Hispanic women. Methods: A retrospective analysis was done with data obtained from 1473 hospitals by National cancer database (NCDB) for the years 2004-2014. Patients with breast cancer were analyzed for differences in treatment offered based on their insurance status. Patients in the insurance group were enrolled under either Private, Medicare, Medicaid or other government insurance. Treatments offered were surgery, chemotherapy, radiation therapy or a combination of the above. Patients with unspecified insurance status and those who were on active surveillance were excluded from the analysis. Results: A total of 2,245,259 patients with breast cancer from all age groups were identified from the registry. 47,294 patients did not have insurance; among which 3275 (7.4%) were not offered any treatment. Among 2,093,809 patients with insurance, 58,726 (2.8%) patients were not offered any treatment. Hence, patients without insurance were twice (OR 2.65; CI 2.55-2.75 p &lt; 0.0001) more likely to not receive any first course treatment. Sub-group analysis for different stages of breast cancer showed; carcinoma in-situ (OR 2.44; CI 2.20-2.71 p &lt; 0.0001), stage1 (OR 2.68; CI 2.43-2.96 p &lt; 0.0001), stage2 (OR 2.86; CI 2.61-3.12 p &lt; 0.0001), and stage 3 (OR 2.56; CI 2.25-2.92 p &lt; 0.0001) have similar odds for not being offered any treatment. However, the odds of receiving treatment were better for stage 4 breast cancer (OR 1.44; CI 1.32-1.55 p &lt; 0.0001). Uninsured Caucasians (OR 2.70; CI 2.56-2.85 p &lt; 0.0001) were less likely to receive any treatment compared to uninsured African-Americans (OR 2.16; CI 2.00-2.33 p &lt; 0.0001) and uninsured Hispanics (OR 1.66; CI 1.52-1.82 p &lt; 0.0001) Conclusions: With the recent suggested changes in health care policy, we can expect the number of uninsured patients to rise and therefore more patients might not have access to breast cancer treatment.

How Do Preoperative Medications Influence Outcomes After Total Joint Arthroplasty?

BackgroundRecent health care policy changes require hospitals and physicians to demonstrate improved quality. In 2012, a prospective database was formed with the Blue Cross and Blue Shield of Michigan to improve quality of care. The purpose of this study was to analyze patient preoperative medication as predictors of outcomes after total joint arthroplasty. MethodsData were collected on patient's preoperative medications from 2012 to 2015 using a total joint arthroplasty database. Medications were categorized as antiplatelet, antimicrobial, anticoagulant, narcotic, steroid, insulin, or oral diabetes medication. Outcomes included hospital length of stay (LOS), discharge disposition/destination, and 90-day readmission. Univariate and multivariate regression analyses were performed. ResultsA total of 3959 patients were studied. Eighty percent (3163 patients) were discharged home. The remainder (795) went to an extended-care facility (ECF). Patients discharged to an ECF were taking more medications (1.13 vs 0.80 in total knee arthroplasty; 1.18 vs 0.83 in total hip arthroplasty; P <.001). Patients who were readmitted took more medications (1.0 vs 0.85; P <.01). There were more discharges to an ECF in narcotic, steroid, and diabetes medication users. Patients taking anticoagulants, narcotics, insulin, and antiplatelets had greater readmission rates. There was a significant correlation between the number of medications and an increased LOS. ConclusionPatients taking more medications were more frequently discharged to an ECF and had increased LOS and readmission rates. Narcotics and diabetic medications had the greatest influence. Category and quantity of preoperative medications can be used as predictors of outcomes after arthroplasty surgery.

Radiation Oncology Physician Practice in the Modern Era: A Statewide Analysis of Medicare Reimbursement.

IntroductionIn recent years, major changes in health care policy have affected oncology practice dramatically. In this context, we examined the effect of practice structure on volume and payments for radiation oncology services using the 2013 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (POSPUF) for New York State radiation oncologists.MethodsThe Medicare POSPUF data was queried, and individual physicians were classified into freestanding office-based and hospital-based practices. Freestanding practices were further subdivided into urology, hematology-oncology, and other ownership structures. Additional variables analyzed included gender, year of medical school graduation, and Herfindahl-Hirschman Index (HHI). Statistical analyses were performed to assess the impact of the above-mentioned variables on reimbursements.ResultsThere were 236 New York State radiation oncologists identified in the 2013 Medicare POSPUF dataset, with a total reimbursement of $91,525,855. Among freestanding centers, the mean global Medicare reimbursement was $832,974. Global Medicare reimbursement was $1,328,743 for urology practices, compared to $754,567 for hematology-oncology practices and $691,821 for other ownership structures (p < 0.05). The mean volume of on-treatment visits (OTVs) was 240.5 per year, varying by practice structure. The mean annual OTV volumes for urology practices, hematology-oncology practices, other freestanding practices, and hospital-based programs were 424.6, 311.5, 247.5, and 209.3, respectively. After correcting for gender, physician experience, and HHI, practice structure was predictive of freestanding reimbursement and on treatment visit volume.ConclusionHigher Medicare payment was significantly predicted by the type of practice structure, with urology-based and hematology-oncology practices accounting for the highest total reimbursement and OTV volume.

Patient characteristics, outcomes and costs following interhospital transfer to a tertiary facility for appendectomy versus patients who present directly

BackgroundRecent healthcare policy changes have emphasized pay-for-performance. Previous studies have not examined outcome differences between primary presenting appendicitis patients and transferred patients. MethodsA retrospective cohort design examined appendicitis patients between March 2011 and 2013. Patients < age 18, were scheduled for an elective appendectomy, who were pregnant or had an interval appendectomy were excluded. ResultsThe transfer cohort (n = 59) had more comorbidities, more severe American Society of Anesthesiologists status, a higher rate of pre-operative abscess/rupture as well as higher rates of perforation, gangrene, intra-operative drain placement and open conversion versus primary presenting patients (n = 622). After statistical regression adjustment, a higher open conversion rate in the transfer cohort, OR = 3.48 (95%CI: 1.04–11.61) and higher total costs $672.47 (95%CI: $68.75-$1276.19) remained. ConclusionsAdjustments in clinical outcome/reimbursement metrics may be needed to address the complexity of transfers and the subsequent higher in-hospital costs on tertiary facilities. Level of evidenceIV.

Trends in the incidence of tooth extraction due to periodontal disease: results of a 12-year longitudinal cohort study in South Korea.

PurposeThis study evaluated trends in tooth extraction due to acute and chronic periodontal disease (PD) using data from the National Health Insurance Service-National Sample Cohort for 2002–2013.MethodsA random sample of 1,025,340 individuals was selected as a representative sample of the population, and a database (DB) of diagnostic and prescription codes was followed up for 12 years. We used multivariate logistic regression analysis to assess the incidence of total extraction (TE), extraction due to periodontal disease (EPD), and immediate extraction due to periodontal disease (IEPD) according to sociodemographic factors (sex, age, household income, health status, and area of residence).ResultsThe incidence of tooth extraction was found to be increasing, and at a higher rate for TE in PD patients. In 2002, 50.6% of cases of TE were caused by PD, and this increased to 70.8% in 2013, while the number of cases of IEPD increased from 42.8% to 54.9% over the same period. The incidence rates of extraction due to acute and chronic PD increased monotonically. We found that the incidence rates of TE, EPD, and IEPD were all 2-fold higher among patients with high income levels and those who were not beneficiaries of health insurance.ConclusionsThe rates of TE, EPD, and IEPD have been steadily increasing despite dental healthcare policies to expand public health insurance coverage, increasing the accessibility of dental clinics. Moreover, the effects of these policies were found to vary with both income and education levels. Consistent patient follow-up is required to observe changes in trends regarding tooth extraction according to changes in dental healthcare policies, and meticulous studies of such changes will ensure optimal policy reviews and revisions.

On the ground floor looking up—Managing trainees' uncertainty at the end of life

Recent US healthcare policy changes set the stage for integrating palliative and end-of-life care into routine medicine. However, these changes may not affect the daily practice of medical trainees—fellows, residents, and medical students—who as front-line care providers are not always equipped with the skills needed to treat terminally ill patients. We review evidence on trainees' discomfort with end-of-life care and highlight limitations of recent policy changes. Key barriers to proficiency include inadequate conversational training, prognostic uncertainty, and unfamiliarity with hospice and palliative care. Educator-, accreditor-, and policy-level interventions may improve trainees' experience caring for seriously ill patients.

Emergency department utilization by Californians with sickle cell disease, 2005-2014.

Clinical care for children and adults living with sickle cell disease (SCD) is often provided in the emergency department (ED). Population-based surveillance data can be used to describe the ED utilization patterns of this patient population. A cohort of pediatric and adult California patients with SCD was identified from multiple data sources, and 10 years (2005-2014) of their treat-and-release ED utilization data were analyzed. Among a cohort of 4,636 patients with SCD, 4,100 (88%) had one or more treat-and-release ED visits. There were 2.1 mean annual visits per person for the cohort (median 0.7; range 0-185). In a single year (2005), 53% had 0 treat-and-release ED visits, 35% had 1-3 visits, 9% had 4-10 visits, and 3% had 11 or more visits; this highest utilization group accounted for 45% of all patients' ED visits. ED utilization in this cohort was highest among young adults and also higher among older adults than pediatric patients. The majority of identified patients in each of the 10 years did not go to the ED, but nearly all had one or more such visits over the full span of time. This study highlights the power and utility of a multisource longitudinal data collection effort for SCD. Further study of the segment of the population with highest ED utilization may highlight areas where changes in healthcare and health policy could improve and extend the lives of patients with SCD.

Development of Integrated Mental Health Services within pediatric ambulatory settings across an academic medical center

Introduction: The need for child mental health services exceeds the availability of trained providers in The United States. Recent changes in health care policy have improved insurance coverage for mental health services, further increasing the number of children and adolescents seeking mental health treatment. With the national shift towards population medicine, it will be more imperative to integrate psychological screening and evidenced based mental health treatments into primary care and to develop efficient models of service delivery in the medical setting.Short description of practice change implemented: In response to these national trends and the local shortage of qualified pediatric mental health professionals, The Division of Child and Adolescent Psychiatry at The Penn State Milton S. Hershey Medical Center (HMC), in collaboration with the Department of Pediatrics, developed a Pediatric Psychiatry Collaborative Care Program (PPCCP). We provide services for both primary care and specialty pediatrics. Our goals include (1) improving access to behavioral health services (2) providing increased support to pediatric medical providers across the campus (3) improving the efficacy of behavioral health treatments offered in pediatric medical settings. The medical site completes brief consultation request forms that are reviewed by the mental health team. Patients are directed to HMC Behavioral Health Clinic if they are thought to have a serious emotional disturbance that would require emergent or long term treatment (e.g. schizophrenia, Bipolar Disorder). Parallel programs were developed for General Pediatrics and Specialty Pediatrics tailored to the needs of the specific patient populations. In both, patients are seen in the office of the medical provider.Key findings: The first program opened in General Pediatrics in April of 2014 and has been expanded several times. Pediatricians are given treatment recommendations that include diagnostic impressions, referrals for psychosocial treatments and, if indicated, clear guidance on beginning and titrating medications. Presently, we provide one clinic per week and are considering adding direct provision of brief psychosocial services in general pediatrics.The specialty pediatrics program began in the late summer of 2015 using a similar design except that it provides psychosocial services using a brief CBT model with the primary targets being internalizing symptoms and the challenges of coping with chronic medical disease. Provision of psychiatry consults was not deemed feasible as most psychotropic medications for these patients are prescribed by generalists outside of the HMC system and not the HMC specialists. All treatment at the specialty pediatrics program occurs in the multi-specialty pediatric clinic. Expedited referrals to our child psychiatry clinic are available for program participants. This program was expanded by adding a rapid screening service led by one of our departmental psychologists embedded in the pediatric GI clinic. Our program faced challenges during the pilot phase, including regulatory requirements for behavioral health, reimbursement issues, administrative staff turnover in the clinics, tracking billing claims and difficulties in changing practice habits of the primary care providers and psychiatrists. To address these concerns we completed an anonymous survey of providers in the General Pediatrics Clinic (response rate 66.6%). We found that 81.8 % providers referred patients to the Consultation clinic with 81.9 % finding the referral process easy, very easy or acceptable. Over 81% providers were satisfied or very satisfied with the quality of the written consultation and 63.6 % found the wait time shorter than what they expected.Highlights: After review of an anonymous survey and other verbal feedback, we expanded the program to offer brief treatment by PPCCP psychiatrists to optimize medication prior to transfer back to the primary care provider. Child Psychiatrists from our inpatient Consultation Liaison team now provide phone consultation, increasing the percentage of the work week that primary care providers can access a child psychiatrist. Different billing systems were developed for each setting to reduce the administrative burden on clinic staff and duplication of resources across departments.Conclusion: The availability of shared electronic medical records was essential to communication between psychiatrist and pediatrician. Other key components were invested leaders in Psychiatry and Pediatrics who met regularly to evaluate the program, identification of an administrative point person for each site who takes ownership of the program and the support of hospital administration who were willing to absorb some of the startup expenses. The program was recently recognized by a system wide award for the extraordinary patient experience and differentiating our health system. Using this model, we plan on expanding to select Family Medicine and other HMC General Pediatric sites outside of the primary medical campus and plan to increase targeted screening services in specific pediatrics specialty programs that are high utilizers of the PPCCP.

Viral Hepatitis in South Korea.

In South Korea (S. Korea), viral hepatitis is a major public health burden. Advances in healthcare policy, evidence-based medicine, and therapeutic strategies in S. Korea have brought a rapid change in the sociodemographic and clinical characteristics of viral hepatitis. This review discusses the innovative approaches that S. Korea has taken to curb the epidemic of viral hepatitis. In addition, the efficacy of various preventive and therapeutic modalities is discussed. This review aims to provide a brief overview to guide future research direction and healthcare policy changes.How to cite this article: Pak SC, Alastal Y, Khan Z, Darr U. Viral Hepatitis in South Korea. Euroasian J Hepato-Gastroenterol 2017;7(2):163-165.

Disparities in Penile Cancer.

Although penile cancer is a rare malignancy in developed nations, racial and socioeconomic differences exist in the incidence of the disease and its associated survival-related outcomes. A search of the literature was performed for research published between the years 1990 and 2015. Case reports and non-English-language articles were excluded, instead focusing specifically on large, population-based studies. The incidence of penile cancer is higher in Hispanic and African American men compared with whites and Asians. Men with penile cancer also appear to have a distinct epidemiological profile, including lower educational and income levels, a history of multiple sexual partners and sexually transmitted infections, and lack of circumcision with the presence of phimosis. African American men presented at a younger age with a higher stage of disease and worse survival rates when compared with white men. Rates of cancer-specific mortality increased with age, single marital status, and among those living in regions of lower socioeconomic status. An understanding of sociodemographical differences in the incidence and survival rates of patients with penile cancer can help advance health care policy changes designed to improve access and minimize disparities in cancer care for all men alike.

HIV is Now a Manageable Long-Term Condition, But What Makes it Unique? A Qualitative Study Exploring Views About Distinguishing Features from Multi-Professional HIV Specialists in North West England

HIV is evolving from a life-threatening infection to a long-term, manageable condition because of medical advances, radical changes in health and social care policy, and the impact of an aging population. However, HIV remains complex, presenting unique characteristics distinguishing it from other long-term conditions (LTCs). Our aim in this qualitative descriptive study was to identify and explore these features in the context of LTCs. A focus group (FG) method was used to gather the views and experiences of multi-professional HIV specialists who worked in North West England. Twenty-four staff participated in FGs (n=3), which were audio recorded, manually transcribed, and thematically analyzed. We found four main themes: (a) stigma, (b) challenges faced by HIV specialists, (c) lack HIV-related knowledge, and (d) unique features, termed "stand alone." We concluded that these distinguishing features hindered full recognition and acceptance of HIV as an LTC.

Health care providers' adherence to tobacco treatment for waterpipe, cigarette and dual users in Vietnam

BackgroundAlmost half of adult men in Vietnam are current cigarette smokers. Recent surveys also suggest a high prevalence of water pipe use, particularly in rural areas. Yet services to treat tobacco dependence are not readily available. The purpose of this study was to characterize current tobacco use treatment patterns among Vietnamese health care providers and factors influencing adherence to recommended guidelines for tobacco use screening and cessation interventions for water pipe, cigarette and dual users. MethodsWe conducted cross sectional surveys of 929 male current tobacco users immediately after they completed a primary care visit at one of 18 community health centers. ResultsThirty-four percent of smokers used cigarettes only, 24% water pipe only, and 42% were dual users. Overall 12% of patients reported that a provider asked them if they used tobacco products during the visit. Providers were significantly more likely to screen cigarette smokers compared with water pipe or dual users (16%, 9% and 11% respectively). Similarly, 9% of current cigarette smokers received advice to quit compared to 6% of water pipe and 5% of dual users. No patients reported that their health care provider offered them assistance to quit (e.g., self-help materials, referral). ConclusionDespite ratifying the Framework Convention on Tobacco Control, Vietnam has not made progress in implementing policies and systems to ensure smokers are receiving evidence-based treatment. High rates of water pipe and dual use indicate a need for health care provider training and policy changes to facilitate treatment for both cigarette and water pipe use.

Barriers to Latino Warehouse Workers’ Health Care: Survey Results from Inland Southern California and Policy Implications

ABSTRACTThis article uses original survey data to explore the barriers to health care access among Latinos who are low-wage warehouse workers, providing a window on health care vulnerabilities of workers of low wages that are especially acute among undocumented immigrants and contingent workers. About one third of respondents had visited a doctor in the past year, whereas about two thirds lacked health insurance. Results from our logistic regression analysis show that, controlling for other factors, unemployed workers, direct hires, and those with health insurance had significantly greater odds than those without these characteristics to have visited a doctor in the past year. Along with changes in immigration and health care policies, reducing employers’ reliance on temporary staffing agencies is imperative for improving these and other low-wage workers’ health care access.

A temporal analysis of opioid use, patient satisfaction, and pain scores in colorectal surgery patients

BackgroundRecent health care policy changes promote objective measurements of patient satisfaction with care provided during hospitalization. Acute postsurgical pain is a significant medical problem and strongly impacts patient experience and patient satisfaction. Multimodal analgesic pathways are used for acute pain management, but opioid medications remain a mainstay of treatment. Opioid use is increasing in the outpatient setting, but opioid use trends in the inpatient postsurgical setting are not well known. We hypothesized that use of opioid medications has increased over time along with decrease in postoperative pain scores and increase in pain-related patient satisfaction. MethodsIn this single-center study, we studied the trends and correlation in the average daily pain scores, opioid consumption, and patient satisfaction scores as measured by pain-related patient satisfaction questions in the Hospital Consumer Assessment of Healthcare Providers and System survey. Pain scores and opioid use data were obtained from electronic health records, vital signs monitoring, and medication databases. Adult patients who had nonemergent colorectal surgeries between January 2009 and December 2012 were included. ResultsWe found no significant trend in opioid use or pain-related patient satisfaction scores. There was an average annual increase of 0.3 (98.3% confidence interval, 0.2-0.4; P< .001) in average daily pain score from 2.8 ± 1.5 to 3.8 ± 1.5. The univariable associations between time-weighted pain score, average daily opioid dose, and pain-related patient satisfaction score were all highly significant. ConclusionIn this retrospective cohort study, opioid use and pain-related patient satisfaction scores were stable over time. Pain-related patient satisfaction scores were negatively associated with both pain score and opioid dose. The associations we report should not be considered evidence of a causal relationship.

Patient Perception of Reimbursement for Arthroscopic Meniscectomy and ACL Reconstruction

Objectives:Healthcare policy changes and decreases in Medicare physician reimbursement continue to change the landscape of healthcare. Historically, patient perceptions of surgeon reimbursement have been exaggerated compared to actual reimbursement. Currently there is limited evidence for patient perception for arthroscopic meniscectomy and ACL reconstruction. The purpose of this study was to evaluate patient perception of physician reimbursement for arthroscopic meniscectomy and ACL reconstruction and to compare health care perceptions between urban and suburban clinics.Methods:Surveys were given to 231 consecutive patients, 127 in an urban clinic and 104 in a suburban clinic. Patients were asked their estimation of reasonable reimbursement for arthroscopic meniscectomy and ACL reconstruction as well as their perception on actual Medicare reimbursement to physicians. They were also asked how much would they be willing to pay out of pocket for the procedures. After revealing actual reimbursement rates, patients were asked if reimbursement levels were appropriate, whether surgeon subspecialty training was important, and if additional compensation should be associated with subspecialty training. Survey responses were compared with respondents in an urban versus a suburban setting as well as amongst income and education level.Results:Patients on average reported surgeons should receive $8,096 for a meniscectomy and $11,794 for an ACL reconstruction, 14 times and 11 times as much as actually reimbursed, respectively. Patients estimated that Medicare paid physicians $5,442 for a meniscectomy and $6,667 for an ACL reconstruction. Patients were willing to pay $2,286 out of pocket for a meniscectomy and $11,793 for an ACL reconstruction. Sixty five percent of patients believed reimbursement for meniscectomy was too low and 57% of patients believe reimbursement for ACL reconstruction was too low. Less than 2% of patients believed physician salaries should be cut, whereas 75% believed physicians should be paid extra for sub-specialty training. There were no differences in payment perception between urban and suburban settings.Conclusion:Patients perceived the values of meniscectomy and ACL reconstruction were substantially higher than current Medicare reimbursement. Majority of patients believed that the current reimbursement is too low and patients on average would be willing to pay more out of pocket than is currently reimbursed.

Patient Perception of Reimbursement for Arthroscopic Meniscectomy and ACL Reconstruction

Healthcare policy changes and decreases in Medicare physician reimbursement continue to change the landscape of healthcare. Patient perception of physician reimbursement historically has been exaggerated. However, there is limited evidence of patient perceptions for arthroscopic meniscectomy and ACL reconstruction. This study evaluates patient perceptions of physician reimbursement for arthroscopic meniscectomy and ACL reconstruction and compares perceptions between urban and suburban clinics. Surveys were given to 231 patients, 127 in an urban and 104 in a suburban clinic. Patients were asked about their estimation of physician reimbursement as well as Medicare reimbursement for arthroscopic meniscectomy and ACL reconstruction. They were also asked how much they would be willing to pay out of pocket for the procedures. After revealing actual reimbursement rates, patients were asked if reimbursement levels were appropriate and additional questions on health care reform. Patients on average believed for a meniscectomy and ACL reconstruction surgeons should receive $8,096 and $11,794 and that Medicare paid physicians $5,442 and $6,667 respectively. Patients were willing to pay $2,286 out of pocket for a meniscectomy and $11,793 for an ACL reconstruction. Sixty five and fifty seven percent of patients believed reimbursement for meniscectomy and ACL reconstruction was too low respectively. Less than 2% of patients believed physician salaries should be cut, whereas 75% believed physicians should be paid extra for sub-specialty training. There were no differences in payment perception between urban and suburban settings. Patients perceived the values of meniscectomy and ACL reconstruction were substantially higher than current Medicare reimbursement. The majority of patients believed that the current reimbursement is too low and patients on average would be willing to pay more out of pocket than is currently reimbursed. Continued decreases in Medicare reimbursements without account of patient values may force physician’s to decline certain insurances, creating a potential for decreased medical access.