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

Clifford C. Sheckter, Oluseyi Aliu, Chad Bailey, Jun Liu, Jesse C. Selber, Charles E. Butler, Anaeze C. Offodile

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalBreast Cancer Research and Treatment
DOIs
StateAccepted/In press - 2021

Keywords

  • Breast reconstruction
  • Cancer
  • Cost conversation
  • Financial toxicity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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