Joint replacement patients willing to pay more for higher star rating, study says

A new study suggests with caveats that patients receiving joint replacement surgery are willing to pay more for services performed by a provider with higher quality ratings.

The study, published Tuesday in Health Affairs, found on average patients would pay $2,607 extra to get their procedure at a hospital with one more star rating and $3,152 more for a physician with one more star.

But the study also finds that the value of star ratings diminish if the patient has prior experience with using ranking systems or receiving surgery.

For a patient who had not used ratings to make a decision about their care, an extra physician star was worth $3,754. By contrast, for patients who had used star ratings before, an extra star was worth $2,820 more.

Similarly, for patients who hadn’t had surgery before, an extra hospital star was worth $2,782.50. By comparison, someone who had undergone surgery was willing to pay only $2,243.25 more for a higher star.

The findings demonstrate the trade-offs patients make when assessing whether to receive care by a particular physician or at a specific facility, said Dr. Adam Schwartz, lead author of the study and an associate professor of orthopedic surgery at the Mayo Clinic College of Medicine.

“We are quantifying what patients view as quality and what they are thinking and there are discrete trade-offs they are willing to make for quality,” he said.

The study doesn’t explain why the value of star ratings diminish if a patient has previously used star ratings or received surgery, Schwartz said, but a hypothesis is that patients with prior experience may be disillusioned by the information the ratings previously offered them. Schwartz said that hypothesis needs to be further studied.

The overall findings are in line with other research showing several factors influence a patient’s choice of providers rather than concrete outcomes data such as physician referral, recommendations from others and convenience such as flexible office hours and distance from home. Out-of-pocket cost is also a big influencer.

The Health Affairs study also shows that patients are willing to pay more on average for higher ranked providers than higher ranked hospitals. Schwartz said that’s a unique finding of the study and needs to be further researched to understand why.

Schwartz and colleagues conducted the study by surveying 200 patients who presented at an orthopedic center for joint pain from January to May 2018. The patients were asked to select three options from four subjects: hospital rating of three, four or five; physician rating of three, four or five; out-of-pocket spending for joint replacement surgery of $200, $1,000 or $4,000; and distance from home to hospital of 10, 100 or 200 miles.

The out-of-pocket spending amounts were based on the CMS Part A inpatient deductible, which was $1,340 at the time of the study’s design. The figures are rounded numbers lower and higher than $1,340.

There are limitations to the study including that the results are just from one joint replacement practice and therefore they can’t be “readily generalizable,” the authors said.


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