Are preference-sensitive surgical procedures a significant cost contributor for Medicare?

Medical conditions with more than one treatment option are termed preference-sensitive conditions. For many preference-sensitive conditions, surgery is one of several treatment options, and in some instances, several types of surgical procedures are available to treat a single condition. Surgical procedures for the subset of preference-sensitive conditions with surgery among their treatment options are termed preference-sensitive surgical procedures (PSSPs).

Variation in rates of surgery for preference-sensitive conditions commonly reflects a lack of strong clinical evidence or an unresolved debate about the efficacy of treatments. For example, greater disagreement among surgeons about the effectiveness of a procedure increases the likelihood of its geographic variation.

There is no industry standard definition or list of PSSPs, and no comprehensive list of PSSPs has been published. In addition, the contribution of PSSPs to total population costs has not been previously reported. However, shared decision-making (SDM) provides patients with a review of conservative and invasive treatment options. Its greatest impact is expected to be on the treatment of preference-sensitive conditions, including the use of PSSPs. Studies demonstrate the potential for the wider adoption of SDM to reduce healthcare costs because as many as 20% of patients who participate in SDM choose less invasive surgical options and more conservative treatment than do patients who do not use decision aids.

In this paper, Milliman’s Kate Fitch, Carol Bazell, and Sumudu Dehipawala focus on 15 PSSPs that may be performed to treat certain preference-sensitive conditions that have surgical treatment options. Their interest is in quantifying the incidence and cost of PSSPs for the Medicare fee-for-service (FFS) population and identifying areas of spending that may provide opportunities for reducing medically unnecessary utilization.