Surgery cost transparency

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A surgeon in Utah is giving appendectomy patients and their families more information and control over their surgeries. (WLS)

When you go to the hardware store to buy a lawnmower, you've probably done research on cost, features, ease of use and more. When you go into surgery, you most likely have none of that information and none of those choices.

So a surgeon in Utah gave appendectomy patients and their families information, control and changed what was happening in the OR.

When Maria Isom was 16, she was rushed to the hospital with appendicitis.

"It was pretty scary because it was my first time ever having surgery, so I was a little freaked out," she said.

Isom's mom, Nancy, wasn't. Doctors gave her choices and information, including costs.

"I thought it was great because we'd been through some financial problems and so giving us a choice of an option that might be a little less expensive was very beneficial to us," Nancy said.

For example: less expensive "open" surgery instruments can be reused. A laparoscopy requires expensive instruments and technology, and disposable equipment. Materials for open procedures cost about $200. Laparoscopic: $3,000. The other difference: laparoscopic scars are smaller. Surgery outcomes are the same.

Dr. Eric Scaife found that two-thirds of informed parents chose open surgery. Surprisingly, 20 percent of parents who weren't told about the cost still picked the open option.

"It was all sorts of interesting things like 'My brother has this, my dad has this scar and I want to have this scar.' You know, 'open operations are cool,'" Scaife, pediatric surgeon at University of Utah Health Care, said.

The study changed things for Dr. Scaife too.

"The year before we did the study, I did zero open appendectomies. And after we did the study, almost half of the operations I did were open," he said.

And Dr. Sciafe says parents overwhelmingly liked being involved in the decision.

Scaife's experiment with medical cost transparency is over, but he believes it could be a powerful tool in driving down health care costs.

BACKGROUND: The last time you bought a television you probably did some research on cost, features, discounts and more. When you go into surgery you have none of that information and none of those choices, but a surgeon at University of Utah Health Care decided to change that. For one year Dr. Eric Scaife laid out the options and costs for appendectomy patients. For the study, pediatric appendicitis patients and their parents were shown one of two videos describing open and laparoscopic appendectomy procedures. The videos were identical, except one of them revealed the price of the surgeries. The study participants then selected their preferred procedure and answered questions about what factors influenced their decision. For example, a laparoscopy requires expensive instruments and technology and disposable equipment, but less expensive "open" surgery instruments can be reused. Materials for open procedures cost about $200, for laparoscopic it's about $3,000. The other difference is that laparoscopic scars are smaller. Surgery outcomes are the same.

THE RESULTS: When parents were informed about the procedures' prices and similar outcomes, almost 66% chose the less-costly open procedure. The study found that parents given the price information were 1.8 times more likely to choose the less-costly option. Dr. Scaife says the results suggest that parents are more likely to choose a less-costly form of surgery regardless of health insurance or economic status. He also says physicians should notify their patients of the price of procedures, while hospitals should do the same for doctors. Dr. Scaife's experiment with medical cost transparency is over, but he believes it could be a powerful tool in driving down health care costs.
(Source: http://www.ncbi.nlm.nih.gov/pubmed/25185471)

NEW ONLINE TOOL: The Health Care Cost Institute (HCCI) has created www.guroo.com, a free, secure, online transparency tool to give patients access to information about the price and quality of health care services. The site uses data from several health insurance companies including Aetna, Humana, and UnitedHealthcare. The website will allow people to see prices for all kinds of health services in their area and be able to compare prices and quality outcomes in different hospitals. This is to give people the opportunity to make informed decisions about which provider or treatment to choose.

CRITICS: Not everyone supports cost transparency. "I have not drunk the Kool-Aid on price transparency," said David Newman, executive director of the Health Care Cost Institute, which compiles data on cost and utilization trends. He says in markets where pricing is very transparent, pricing tends to narrow and the average cost rises. In healthcare specifically, hospitals may become price-competitive only on selective services or those they are required to publicize, he noted.
(Source: http://www.healthcostinstitute.org/files/Final%205-19-14%20FAQs.pdf)
(Source: http://www.ajmc.com/journals/issue/2014/2014-11-vol20-SP/Overcoming-Barriers-to-a-Research-Ready-National-Commercial-Claims-Database)

For More Information, Contact:
Julie Kiefer
jkiefer@neuro.utah.edu

Related Topics:
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