Financial Distress and Discussing the Cost of Total Joint Arthroplasty

Background: Total joint arthroplasty is expensive. Out-of-pocket cost to patients undergoing elective total joint arthroplasty varies considerably depending on their insurance coverage but can range into the tens of thousands of dollars. The goal of this study is to evaluate the association between patient financial stress and interest in discussing costs associated with surgery. Methods: One hundred forty-one patients undergoing elective total hip and knee arthroplasty at a suburban academic medical center were enrolled and completed questionnaires about cost prior to surgery. Questions regarding if and when doctors should discuss the cost of healthcare with patients, evaluating if patients were affected by the cost of healthcare and to what extent, and financial security scores to assess current financial situation were included. The primary outcome was the answer to the question of whether a doctor should discuss cost with patients. Results: Financial stress was found to be associated with patient experience of hardship due to cost of care [P = .004], likelihood to turn down a test or treatment due to copayment [P = .029], to decline a test or treatment due to other costs [P = .003], to experience difficulty affording basic necessities [P = .008], and to have used up all or most of their savings to pay for surgery [P = .011]. In total, 84% of patients reported that they wanted to discuss surgical costs with their doctors, but 90% did not want to do so at every visit. Conclusion: Total joint arthroplasty creates considerable out-of-pocket costs that may affect patient decisions. These findings help elucidate important patient concerns that orthopedic surgeons should account for when discussing elective arthroplasty with patients. (C) 2018 Elsevier Inc. All rights reserved.