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

Abstract

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.

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Acknowledgements

We acknowledge Erica Goodoff, ELS (D) of Editing Services, and Research Medical Library at MD Anderson Cancer Center for contributions to editing.

Funding

This research was supported by funds from the University Cancer Foundation via the Sister Institution Network Fund (SINF) at The University of Texas MD Anderson Cancer Center.

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Correspondence to Anaeze C. Offodile II.

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The senior author (ACO) has received research funding from Blue Cross Blue Shield Affordability Cures Consortium and National Academy of Medicine unrelated to the submitted work. He is also an advisory board member of the Patient Advocate Foundation.

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Sheckter, C.C., Aliu, O., Bailey, C. et al. 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. Breast Cancer Res Treat (2021). https://doi.org/10.1007/s10549-020-06085-4

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Keywords

  • Breast reconstruction
  • Cost conversation
  • Financial toxicity
  • Cancer