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 The misperceptions among spinal surgery patients are
emblematic of a major barrier to controlling healthcare costs,
according to the authors, which is that nobody knows what the costs
are.
"You're buying a service, and you don't know what you're getting,"
the study's lead author, Dr. K. Linnea Welton, told Reuters Health.
"I think there's something to be said for a more black-and-white
system so patients know what they're buying and they can make more
educated decisions."
Welton is an orthopedic surgery resident at the University of
Michigan.
Health-policy professor Stephen Shortell of the University of
California, Berkeley, also thinks transparency would improve the
U.S. healthcare system.
"The underlying message of the study is that the American consumer
is blind, has no idea of the cost of healthcare," he told Reuters
Health. "It is totally unlike any other sector of the American
economy. The system is byzantine."
Healthcare providers and insurers have included in their contracts
prohibitions against disclosing prices and payments, though some
states have begun to outlaw the gag clauses, added Shortell, who was
not involved in the new study.
To get a sense of what orthopedic surgery patients knew or believed
about surgeon reimbursements, Welton and her colleagues mailed
12-question surveys to 385 patients who underwent spine procedures
from 2010 to 2011. Only 103 of the patients, or 27 percent,
responded to the surveys.
About three quarters of the respondents had undergone a major
procedure on the spine, such as cervical fusion or lumbar fusion,
and a quarter had minor procedures such as discectomy.
Of the respondents who underwent minor surgery, 62 percent believed
their surgeons earned thousands of dollars more for the procedures
than they did, according to the results published in The Spine
Journal.
For minor procedures, patients estimated reimbursement was between
$5,000 and $10,000, whereas the highest reimbursement for any minor
procedure from Medicare was $1,363 and from a private insurer,
$2,038.
Of the respondents who underwent major surgery, 28 percent estimated
that insurance compensated their surgeons something above $15,000 -
which is more than $8,000 in excess of the highest actual
reimbursement.
In addition, the patients assumed the
surgeons were paid additional fees for postoperative visits, when in
reality the initial payments covered all surgical care for three
months, Welton said.
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Many survey participants also overestimated their surgeons'
annual salaries, Welton said. Some 22 percent of respondents
estimated their surgeons earned between $500,000 and $750,000
annually. In fact, 68 percent of orthopedic spine surgeons earn less
than $750,000, Welton and her colleagues point out.
According to a 2012 survey of doctors, orthopedic surgeons earned
more than physicians in any other specialty, with a median
compensation of $563,074.
"I believe the American public is correct to believe that orthopedic
surgeons are overpaid, because they are," labor economist J. Paul
Leigh told Reuters Health in an email.
In a 2010 study, Leigh says he showed that orthopedic surgeons
earned roughly $2.2 million more in their lifetimes than family
practice physicians, after controlling for varying length of
residency years, work hours, gender, age and other salary
predictors.
A professor at the Center for Healthcare Policy and Research at the
University of California, Davis, Leigh was not involved in the
current study.
Welton said the intent of her study was not to push for higher
salaries for orthopedic surgeons but to shine light on the knowledge
gaps.
"It's not to say we should be paid more," she said. "It's to say
patients value what we do, and we don't as a population have a good
idea of how our healthcare dollars are allocated."
"Most Americans value their personal physicians," Shortell said.
"But the costs of healthcare in the U.S. are so high, and the
outcomes are so low compared to other countries. The issue is we're
not getting value for the money we're spending."
SOURCE: bit.ly/1cJQfNG
The Spine Journal, online February 10, 2014.
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