Consumerism Shapes and Dominates Orthopedic Care

Orthopedics, as with every other industry, is no stranger to consumerism. Healthcare consumerism, as a broader umbrella including all of medicine, is boosting competition among ASCs while patients gain increasing control over their own healthcare decisions. Examples of this increased control are evident in the ability to pick a surgical site and “shop” for the best value in healthcare. And, as a consequence of this rampant consumerism, price, the customer experience, and convenience matter more than ever. 

Battle for Price

The incessant demand from patients and payers for lower-cost procedures has only accelerated with the movement towards high-deductible plans. 

High-deductible plans are the standard for employer-sponsored coverage. Since 2016, the number of big employers offering a high-deductible health plan (HDHP) has increased by 20%. In the year 2018, 70% of large employers offered at least one HDHP. These plans — which offer lower monthly premiums in return for high deductibles — encourage consumers to make cost-conscious decisions. 

Since consumers with HDHPs are incentivized to shop for their own healthcare, providers need a balance of direct-to-consumer marketing and a powerful digital presence in order to attract patients. Websites with a menu of procedures accompanied by price have become the norm. A well-displayed offering defines more than patient benefit — bringing in the physician and surrounding community as well. Value propositions and highlighted convenience are all part of the best packages. 

Price-sensitive consumers have even more reasons to be financially aware as government regulations continue to modify existing healthcare systems and the popularity of HDHPs shifts. Websites and tools designed to provide price transparency are expected, albeit the historical trend of hidden healthcare prices. 

Price Transparency Provisions

Effective January 1, 2019, The Centers for Medicare & Medicaid Services (CMS) set in place the hospital price transparency policy, which dictated that hospitals must make a list of their standard charges available. This is a representation of a larger trend within the healthcare industry to move towards price transparency. Concern surrounding existing transparency — or lack thereof — is catalyzed by surprising out-of-network bills, seemingly arbitrary out-of-pocket costs, and overall confusion regarding market prices.

In addition, CMS also proposed a requirement to make a consumer-friendly portal for payer-specific negotiated charges which would initially apply to 300 services. This piece of the proposal, however controversial, hopes to provide “consumer-friendly” information for the wide variety of “shoppable” services. Hospitals that violate the hospital price transparency provisions are subject to penalties of up to $300 per day. 

CMS is actively working toward offering patients increased access to price information and health records, with a goal to achieve far more transparency than exists in today’s healthcare system. As a result of a more “shoppable” process, hospitals will be able to operate with more flexibility and patients can make intentional, individualized decisions about their own healthcare. 

Expected Convenience

The expectation of convenience from patients dovetails with the promise of flexibility from providers. A large variety of site care locations is just the beginning of flexible, adaptable healthcare. The number of outpatient procedures is trending upwards, demanding that web-based modules and other technology be implemented to communicate with patients outside hospital environments. Preoperative education, rehab, and postoperative instructions are all elements of patient care that can be shifted online to further enhance convenience. 

Multispecialty provider co-location and virtual health live at the intersection of episodic care and consumerism. As with all aspects of healthcare, however, research is necessary to determine exactly how patient populations prefer to be served. With regard to co-locations, men prefer co-located services more than women, and younger patients prefer co-location when compared with their older counterparts. In addition, Medicaid patients find co-location to be more valuable than Medicare and privately-insured patients. 

The orthopedic market — including systems and devices — continually welcomes new players, thus intensifying the existing variability. Consumerism drives policy, innovation, and systems of care, which all also contribute to the innumerable orthopedic patient offerings. Thankfully, growing transparency highlights the patient experience, price, and convenience to help patients choose facilities based on value — encouraging healthy competition across all providers.