STUDY: PATIENTS, NOT SURGEONS, DRIVING DEMAND FOR SURGERY (Orthopedics This Week)
Study: Patients Want MORE Surgery
According to a new study, it’s not the doctors that are pushing for surgeries. It’s the patients! Chad Mather, M.D., an attending orthopedic surgeon at Duke University, and a former AAOS [American Academy of Orthopaedic Surgeons] Washington Health Policy Fellow, tells OTW, “We are working on an exciting new area of study in the field of personalized and customized medicine. This is an effort that grew out of my policy work in traditional economic analysis which commonly compares two interventions. I observed that in simulations of these models that while we could determine if strategy A or B was better for a population of patients, some patients had better outcomes with A and some with B. Therefore, the best strategy was not to pick between treatment A or B, but rather to get treatment A and B to the right patients. Our current work utilizes a common marketing research tool, conjoint analysis which involves a personalized assessment of risks and tradeoffs to measure patient preferences. Our pilot work focuses on the treatment decision for a first time anterior shoulder dislocation and over 50% of respondents chose surgery with cost sharing at $1,000 cost share and 42% at $2,000. A full 90% of patients chose surgery if they had only one more recurrence.”
“At the same time, epidemiological data suggests only 37% of patients ever have surgery after a first time anterior shoulder dislocation. These findings suggest that according to patient preferences, we are actually underutilizing not overutilizing surgical treatment. We are still in the early stages of this project and more testing is required to confirm these early results. However, if these trends continue and occur in other orthopaedic conditions, this data could refute the influence of supplier induced demand causing over-utilization of orthopaedic surgery. Orthopaedic surgeons continue to argue that current utilization is appropriate, but we might be wrong after all—in fact, some orthopaedic surgeries might be actually be underutilized!”