What Is The Value Of A Star When Choosing A Provider For Total Joint Replacement? A Discrete Choice Experiment

Schwartz, Adam J.; Yost, Kathleen J.; Bozic, Kevin J.; Etzioni, David A.; Raghu, T. S.; Kanat, İrfan Emrah

doi:10.1377/hlthaff.2020.00085

Cited by 16 publications

(18 citation statements)

References 31 publications

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“…One concern with increased travel distances might be an association with increasing complication/readmission rates; however, prior studies have not found a link between travel distance and complications in primary TJA [34,44]. Additionally, increased travel times impose a cost on patients, and for primary TJA, patients were willing to pay an extra USD 11.45 out of pocket to avoid traveling per mile for arthroplasty care, which means patient preferences will need to be further evaluated [42]. Careful planning of centralization may mitigate the effects of travel distance on patients; for example, for pancreaticoduodenectomy, a centralized care model design predicted that all patients in California could be directed to a high-volume institution without creating additional travel burdens [13].…”

Section: Effect Of Centralization On Patient Demographic Characteristicsmentioning

confidence: 99%

Does Hypothetical Centralization of Revision THA and TKA Exacerbate Existing Geographic or Demographic Disparities in Access to Care by Increased Patient Travel Distances or Times? A Large-database Study

Ramirez

Myers

Thirukumaran

et al. 2021

Clin Orthop Relat Res

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Background Higher hospital volume is associated with lower rates of adverse outcomes after revision total joint arthroplasty (TJA). Centralizing revision TJA care to higher-volume hospitals might reduce early complication and readmission rates after revision TJA; however, the effect of centralizing revision TJA care on patient populations who are more likely to experience challenges with access to care is unknown. Questions/purposes (1) Does a hypothetical policy of transferring patients undergoing revision TJA from lower-Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Ethical approval for this study was waived by the University of Rochester Institutional Review Board.

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Section: Effect Of Centralization On Patient Demographic Characteristicsmentioning

confidence: 99%

Does Hypothetical Centralization of Revision THA and TKA Exacerbate Existing Geographic or Demographic Disparities in Access to Care by Increased Patient Travel Distances or Times? A Large-database Study

Ramirez

Myers

Thirukumaran

et al. 2021

Clin Orthop Relat Res

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“…5 Further, a recent study using a discrete choice experiment with joint replacement patients demonstrated large (though hypothetical) willingness to pay for physicians and hospitals with higher star ratings and a modest willingness to pay for reduced travel distance. 6 Tradeoffs between distance and quality also arise as policy considerations. For services where higher volume is associated with better outcomes, concentrating care in "centers of excellence" would require patients to sacrifice proximity for quality.…”

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confidence: 99%

Understanding the Tradeoffs Between Travel Burden and Quality of Care for In-center Hemodialysis Patients

et al. 2021

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Background: Renal dialysis is a lifesaving but demanding therapy, requiring 3 weekly treatments of multiple-hour durations. Though travel times and quality of care vary across facilities, the extent to which patients are willing and able to engage in weighing tradeoffs is not known. Since 2015, Medicare has summarized and reported quality data for dialysis facilities using a star rating system. We estimate choice models to assess the relative roles of travel distance and quality of care in explaining patient choice of facility.Research Design: Using national data on 2 million patient-years from 7198 dialysis facilities and 4-star rating releases, we estimated travel distance to patients' closest facilities, incremental travel distance to the next closest facility with a higher star rating, and the difference in ratings between these 2 facilities. We fit mixed effects logistic regression models predicting whether patients dialyzed at their closest facilities.Results: Median travel distance was 4 times that in rural (10.9 miles) versus urban areas (2.6 miles). Higher differences in rating [odds ratios (OR): 0.56; 95% confidence interval (CI): 0.50-0.62] and greater area deprivation (OR: 0.50; 95% CI: 0.48-0.53) were associated with lower odds of attending one's closest facility. Stratified models were also fit based on urbanicity. For rural patients, excess travel was associated with higher odds of attending the closer facility (per 10 miles; OR: 1.05; 95% CI: 1.04-1.06). Star rating differences were associated with lower odds of receiving care from the closest facility among urban (OR: 0.57; 95% CI: 0.51-0.63) and rural patients (OR: 0.18; 95% CI: 0.08-0.44).Conclusions: Most dialysis patients have higher rated facilities located not much further than their closest facility, suggesting many patients could evaluate tradeoffs between distance and quality of care in where they receive dialysis. Our results show that such tradeoffs likely occur. Therefore, quality ratings such as the Dialysis Facility Compare (DFC) Star Rating may provide actionable information to patients and caregivers. However, we were not able to assess whether these associations reflect a causal effect of the Star Ratings on patient choice, as the Star Ratings served only as a marker of quality of care.

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“…If quality is salient and valued by consumers, information can encourage providers to invest in higher quality. One discrete choice experiment found that patients needing a total joint replacement were willing to pay $2,600–$3,100 for a hospital or physician with one more star (Schwartz et al, 2021).…”

Section: Theory Data and Methodsmentioning

confidence: 99%

Should patients use online reviews to pick their doctors and hospitals?

Hyman¹,

Liu

Black

2022

J Empirical Legal Studies

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We compare the online reviews of 221 “Questionable” Illinois and Indiana physicians with multiple paid medical malpractice claims and disciplinary sanctions with matched control physicians with clean records. Across five prominent online rating services, we find small, mostly insignificant differences in star ratings and written reviews for Questionable versus control physicians. Only one rating service (Healthgrades) reports on paid medical malpractice claims and disciplinary actions and it misses more than 90% of these actions. We also evaluate the online ratings of 171 Illinois hospitals and find that their ratings are largely uncorrelated with the share of hospital‐affiliated physicians with paid medical malpractice claims and disciplinary sanctions. Online ratings have limited utility in helping patients avoid physicians with troubled medical malpractice and disciplinary records, and steering patients away from hospitals at which more physicians have paid medical malpractice claims and disciplinary sanctions.

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What Is The Value Of A Star When Choosing A Provider For Total Joint Replacement? A Discrete Choice Experiment

Cited by 16 publications

References 31 publications

Does Hypothetical Centralization of Revision THA and TKA Exacerbate Existing Geographic or Demographic Disparities in Access to Care by Increased Patient Travel Distances or Times? A Large-database Study

Does Hypothetical Centralization of Revision THA and TKA Exacerbate Existing Geographic or Demographic Disparities in Access to Care by Increased Patient Travel Distances or Times? A Large-database Study

Understanding the Tradeoffs Between Travel Burden and Quality of Care for In-center Hemodialysis Patients

Should patients use online reviews to pick their doctors and hospitals?

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