Limited Access to Aortic Valve Procedures in Socioeconomically Disadvantaged Areas.

BACKGROUND: To explore how differences in local socioeconomic deprivation impact access to aortic valve procedures and the treatment of aortic valve disease, in comparison to other open and minimally invasive surgical procedures. METHODS AND RESULTS: Procedure volume data were obtained from the Healthcare Cost and Utilization Project from 18 states from 2016 to 2019 and merged with area deprivation index data, an index of zip code-level socioeconomic distress. We estimate the relationship between local deprivation ranking and differences in volumes of aortic valve replacement, which include transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), versus coronary artery bypass graft surgery and laparoscopic colectomy (LC). All regressions control for state and year fixed effects and an array of zip code-level characteristics. TAVR procedures have increased over time across all zip codes. The rate of increase is negatively correlated with deprivation ranking, regardless of the higher share of hospitalizations per population in high deprivation areas. Distributional analysis further supports these findings, showing that lower area deprivation index areas account for a disproportionately large share of SAVR, TAVR, and LC procedures in our sample relative to their share of all hospitalizations in our sample. By comparison, the cumulative distribution of coronary artery bypass graft procedures was nearly identical to that of total hospitalizations, suggesting that this procedure is equitably distributed. Regressions show high area deprivation index areas have lower prevalence of SAVR (ß=-15.1%, [95% CI, -26.8 to -3.5]), TAVR (ß=-9.1%, [95% CI, -18.0 to -0.2]), and LC (ß=-19.9%, [95% CI, -35.4 to -4.4]), with no statistical difference in the prevalence of coronary artery bypass graft (ß=-2.5%, [95% CI, -12.7 to 7.6]), a widespread and commonly performed procedure. In the population aged ≥80 years, results show high area deprivation index areas have a lower prevalence of TAVR (ß=-11.9%, [95% CI, -18.7 to -5.2]) but not SAVR (ß=-0.8%, [95% CI, 8.1 to 6.3]), LC (ß=-3.5%, [95% CI, -13.4 to -6.4]), or coronary artery bypass graft (ß=5.2%, [95% CI, -1.1 to 1.1]). CONCLUSIONS: People living in high deprivation areas have less access to life-saving technologies, such as SAVR, and even moreso to device-intensive minimally invasive procedures such as TAVR and LC.

Hospital ownership and admission rates from the emergency department, evidence from Florida.

OBJECTIVE: In light of Department of Justice investigations of for-profit chains for over-admitting patients, we sought to evaluate whether for-profit hospitals are more likely to admit patients from the emergency department. DATA SOURCES: We used statewide visit-level inpatient and emergency department records from Florida's Agency for Healthcare Administration for 2007-2019. STUDY DESIGN: We calculated differences in admission rates between for-profit and other hospitals, adjusting for patient and hospital characteristics. We also estimated instrumental variables models using differential distance to a for-profit hospital as an instrument. DATA COLLECTION/EXTRACTION METHODS: Our main analysis focuses on patients ages 65 and older treated in hospitals that primarily serve adults. PRINCIPAL FINDINGS: Adjusted admission rates among patients ages 65 and older were 7.1 percentage points (95% CI: 5.1-9.1) higher at for-profit hospitals in 2019 (or 18.8% of the sample mean of 37.8%). Differences in admission rates have remained constant since 2009. CONCLUSION: Our results are consistent with allegations that for-profit hospitals maintain lower admission thresholds to increase occupancy levels.

The Relationship Between Scope of Practice Laws for Task Delegation and Nurse Turnover in Home Health.

OBJECTIVE: Nurse turnover can compromise the quality and continuity of home health care. Scope of practice laws, which determine the tasks nurses are allowed to perform and delegate, are an important element of autonomy and vary across states. In this study, we used human resource records from a multistate home health organization to examine the relationship between nurse turnover and whether nurses can delegate tasks to unlicensed aides. DESIGN: A retrospective, cross-sectional analysis. SETTING AND PARTICIPANTS: The study sample included 1820 licensed practical nurses and 3309 registered nurses, who spanned 30 states. The study period was 2016 through 2018. METHODS: We used weighted least squares to study the relationship between nurse turnover for registered and licensed practical nurses and task delegation across state-years. We measured task delegation continuously (0-16 tasks) and as a binary variable (14 or more tasks, which indicated the state was in the top half of the distribution). RESULTS: Across state-years, the turnover rate was 30.8% for licensed practical nurses and 36.8% for registered nurses. Although there was no significant relationship between task delegation and turnover among registered nurses, we found that states in which nurses could delegate the most tasks had lower turnover rates among licensed practical nurses. CONCLUSION AND IMPLICATIONS: The ability to delegate tasks to unlicensed aides was correlated with lower turnover rates among licensed practical nurses, but not among registered nurses. This suggests that the ability to delegate tasks is more likely to affect the workload of licensed practical nurses. This also points to a potential and unexplored element of expanding the scope of practice for nurses: reduced turnover. Given the added work-related hazards associated with home health care, including working in isolation, a lack of social recognition, and inadequate reimbursement, states should consider whether changes in their policy environment could benefit nurses working in home health.

On resource allocation in health care: The case of concierge medicine.

Resource allocation generally involves a tension between efficiency and equity, particularly in health care. The growth in exclusive physician arrangements using non-linear prices is leading to consumer segmentation with theoretically ambiguous welfare implications. We study concierge medicine, in which physicians only provide care to patients paying a retainer fee. We find limited evidence of selection based on health and stronger evidence of selection based on income. Using a matching strategy that leverages the staggered adoption of concierge medicine, we find large spending increases and no average mortality effects for patients impacted by the switch to concierge medicine.

Green function estimates on complements of low-dimensional uniformly rectifiable sets.

It has been recently established in David and Mayboroda (Approximation of green functions and domains with uniformly rectifiable boundaries of all dimensions. arXiv:2010.09793) that on uniformly rectifiable sets the Green function is almost affine in the weak sense, and moreover, in some scenarios such Green function estimates are equivalent to the uniform rectifiability of a set. The present paper tackles a strong analogue of these results, starting with the "flagship" degenerate operators on sets with lower dimensional boundaries. We consider the elliptic operators L ß , γ = - div D d + 1 + γ - n ∇ associated to a domain Ω âŠ‚ R n with a uniformly rectifiable boundary Γ of dimension d < n - 1 , the now usual distance to the boundary D = D ß given by D ß ( X ) - ß = ∫ Γ | X - y | - d - ß d σ ( y ) for X ∈ Ω , where ß > 0 and γ ∈ ( - 1 , 1 ) . In this paper we show that the Green function G for L ß , γ , with pole at infinity, is well approximated by multiples of D 1 - γ , in the sense that the function | D ∇ ( ln ( G D 1 - γ ) ) | 2 satisfies a Carleson measure estimate on Ω . We underline that the strong and the weak results are different in nature and, of course, at the level of the proofs: the latter extensively used compactness arguments, while the present paper relies on some intricate integration by parts and the properties of the "magical" distance function from David et al. (Duke Math J, to appear).

Dans David and Mayboroda (Approximation of green functions and domains with uniformly rectifiable boundaries of all dimensions. arXiv:2010.09793) il est démontré que pour les domaines à bord uniformément rectifiable, la fonction de Green vérifie des estimations faibles de bonne approximation par des fonctions affines, avec une réciproque vraie dans certains cas encourageants. Ici on part de la rectifiabilité uniforme et on démontre les estimations fortes naturelles d'approximation de la fonction de Green, et aussi des solutions, par des applications affines (ou, de manière équivalente, des multiples de la distance au bord adoucie). L'étude inclut les analogues naturels du Laplacien dans les domaine dont la frontière est de grande co-dimension. On considère les opérateurs elliptiques L ß , γ = div D d + 1 + γ - n ∇ associés à un domaine Ω âŠ‚ R n dont le bord Γ est Ahlfors régulier et uniformément rectifiable de dimension d < n - 1 et à la distance au bord maintenant usuelle D = D ß définie par D ß ( X ) - ß = ∫ Γ | X - y | - d - ß d σ ( y ) pour X ∈ Ω , où ß > 0 et γ ∈ ( - 1 , 1 ) sont des paramètres et σ une mesure Ahlfors régulière sur Γ . Les auteurs ont montré précédemment que la mesure elliptique associée à L ß , γ est bien définie et est mutuellement absolument continue par rapport à σ , avec un poids de A ∞ . Ici on démontre que la fonction de Green G avec pôle à l'infini associée à L ß , γ est bien approchée par les multiples de D, au sens où la fonction | D ∇ ( ln ( G D 1 - γ ) ) | 2 vérifie une condition de Carleson sur Ω . Ces nouvelles estimations sont différentes en nature. Les estimations de David and Mayboroda (Approximation of green functions and domains with uniformly rectifiable boundaries of all dimensions. arXiv:2010.09793) reposaient sur des arguments de compacité; ici on a besoin d'estimations plus précises, obtenues par intégration par parties et en utilisant les propriétés algébriques de la fonction D α dans le cas"magique" de David et al. (Duke Math J, to appear).

The effect of performance pay incentives on market frictions: evidence from medicare.

Medicare has increased the use of performance pay incentives for hospitals, with the goal of increasing care coordination across providers, reducing market frictions, and ultimately to improve quality of care. This paper provides new empirical evidence by using novel operations and claims data from a large, independent home health care firm with the Hospital Readmissions Reduction Program (HRRP) penalty on hospitals providing identifying variation. We find that the penalty incentive to reduce re-hospitalizations passed through from hospitals to the firm for at least some types of patients, since it provided more care inputs for heart disease patients discharged from hospitals at greater penalty risk and that contributed more patients to the firm. This evidence suggests that HRRP helped increase coordination between hospitals and home health firms without formal integration. Greater home health effort does not appear to have led to lower patient readmissions.

Nursing turnover in a large, rural health system.

PURPOSE: Nursing turnover is a leading cause of inefficiency in health care delivery. Few studies have examined turnover among nurses who work in rural areas. METHODS: We accessed human resources data that tracked hiring and terminations from a large health system operating in South Dakota, North Dakota, and Minnesota between January 2016 and December 2017. Our study sample included 7,634 registered nurses, 1,765 of whom worked in a rural community. Within the health system, there were 27 affiliated hospitals, 17 of which were designated critical access hospitals. We estimated nursing turnover rates overall and stratified turnover rates by available demographic and occupational characteristics, including whether the nurse worked in a community with an affiliated acute care hospital or critical access hospital. FINDINGS: Overall, 19% of nurses left their position between January 2016 and December 2017. Turnover rates were associated with state, nurse gender and age, and occupational tenure, but were similar in urban and rural areas. Of note, turnover rates were significantly higher in communities without an affiliated acute care hospital or critical access hospital. CONCLUSION: Between 2016 and 2017, nearly 1 in 5 nurses working in this health system left their position. Turnover rates differed based on nurse demographics and selected occupational characteristics, including tenure. We also found higher turnover rates among nurses who worked in communities without an affiliated hospital, which points to a potential but unexplored benefit of hospitals in rural areas.

A systematic review of research on empathy in health care.

OBJECTIVE: To summarize the predictors and outcomes of empathy by health care personnel, methods used to study their empathy, and the effectiveness of interventions targeting their empathy, in order to advance understanding of the role of empathy in health care and facilitate additional research aimed at increasing positive patient care experiences and outcomes. DATA SOURCE: We searched MEDLINE, MEDLINE In-Process, PsycInfo, and Business Source Complete to identify empirical studies of empathy involving health care personnel in English-language publications up until April 20, 2021, covering the first five decades of research on empathy in health care (1971-2021). STUDY DESIGN: We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. DATA COLLECTION/EXTRACTION METHODS: Title and abstract screening for study eligibility was followed by full-text screening of relevant citations to extract study information (e.g., study design, sample size, empathy measure used, empathy assessor, intervention type if applicable, other variables evaluated, results, and significance). We classified study predictors and outcomes into categories, calculated descriptive statistics, and produced tables to summarize findings. PRINCIPAL FINDINGS: Of the 2270 articles screened, 455 reporting on 470 analyses satisfied the inclusion criteria. We found that most studies have been survey-based, cross-sectional examinations; greater empathy is associated with better clinical outcomes and patient care experiences; and empathy predictors are many and fall into five categories (provider demographics, provider characteristics, provider behavior during interactions, target characteristics, and organizational context). Of the 128 intervention studies, 103 (80%) found a positive and significant effect. With four exceptions, interventions were educational programs focused on individual clinicians or trainees. No organizational-level interventions (e.g., empathy-specific processes or roles) were identified. CONCLUSIONS: Empirical research provides evidence of the importance of empathy to health care outcomes and identifies multiple changeable predictors of empathy. Training can improve individuals' empathy; organizational-level interventions for systematic improvement are lacking.

On the impact of predictive analytics-driven disease management interventions.

OBJECTIVES: To evaluate the effect of a predictive algorithm-driven disease management (DM) outreach program compared with non-predictive algorithm-driven DM program participation on health care spending and utilization. STUDY DESIGN: We used propensity score matching forMedicare Advantage members with chronic heart failure (CHF) to evaluate the impact of predictive algorithm-driven DM outreach using claims data from 2013 to 2018 from a large commercial health insurer. METHODS: The insurer ran a predictive algorithm to identify members with CHF with a high likelihood of hospitalization (LOH), and a DM outreach was initiated to those identified as being at high risk of hospitalization (high-LOH intervention group). The intervention group was matched to members with similar concurrent medical risk profiles, based on the DxCG/Verisk score, who received the same DM outreach through the insurer's standard process (low-LOH intervention group). This approach allowed an evaluation of the predictive algorithm in targeting individuals suitable for DM outreach. RESULTS: Regression models showed that high-LOH intervention members had a lower probability of hospitalization (0.032; P = .075) and emergency department (ED) visit (0.039; P = .043) in the year after the outreach compared with low-LOH intervention members, leading to lower total outpatient spending ($1517; P < .001). Analyses for no-intervention members showed that predictive outreach members would have been expected to have higher inpatient and ED utilization and higher medical spending compared with the traditional care members. CONCLUSIONS: A prediction-driven DM outreach program among patients with CHF was effective in reducing medical spending in the year after the outreach compared with traditional DM outreach programs.

The unintended consequences of Medicare's wage index adjustment on device-intensive hospital procedures.

OBJECTIVES: To study the association between Medicare's wage index adjustment and the differential use of labor-intensive surgical procedures and medical device-intensive minimally invasive clinical procedures across the United States. STUDY DESIGN: We combine a conceptual model and an empirical investigation of its predictions, applied to aortic valve replacement, to study the relationship between variation in Medicare wage index payment adjustment across hospital referral regions (HRRs) and the utilization of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in these areas. METHODS: Using detailed individual Medicare claims data for 2013-2018 and a novel geographical crosswalk to nest information on Medicare's wage index and utilization of TAVR and SAVR, we estimate a mixed effects Poisson regression model across HRRs to test our hypotheses. RESULTS: We find regional variation in Medicare wage index adjustment levels to be correlated with differential TAVR and SAVR utilization and growth over time. In particular, in HRRs where the wage index is half the national mean there is a 35% decline in the rate of TAVR use and in HRRs where the wage index is 50% higher than the national mean there is a 52% increase in the rate of TAVR use. CONCLUSIONS: Consistent with our framework and hypothesis, our results highlight the importance of adjusting Medicare hospital inpatient payments for device-intensive procedures. Absent such adjustment, access to appropriate interventions may be reduced in areas with low wage index, and lower reimbursement, when driven by wage index adjustment, may influence the treatment approach selected.

Information, relative skill, and technology abandonment.

We study the role of relative task-specific skill in explaining the heterogeneity in physicians' technology abandonment decisions in response to negative information shocks. We show that after an unexpected FDA safety warning on the use of minimally invasive hysterectomies, physicians alter their procedural mix towards open procedures and away from the minimally invasive procedures. This effect is less pronounced for physicians more skilled in performing minimally invasive procedures relative to open procedures, highlighting relative skill as an explanation for differential technology abandonment. Since physicians with higher relative skill are more likely to use minimally invasive procedures before the FDA safety communication, we find that the FDA intervention led to a substantial increase in practice variation across physicians with different relative skill levels. These findings are consistent with a theoretical model that predicts physicians' response to new information regarding the effectiveness of medical technology.

Telemedicine catches on: changes in the utilization of telemedicine services during the COVID-19 pandemic.

OBJECTIVES: To determine the degree of telemedicine expansion overall and across patient subpopulations and diagnoses. We hypothesized that telemedicine visits would increase substantially due to the need for continuity of care despite the disruptive effects of COVID-19. STUDY DESIGN: A retrospective study of health insurance claims for telemedicine visits from January 1, 2018, through March 10, 2020 (prepandemic period), and March 11, 2020, through October 31, 2020 (pandemic period). METHODS: We analyzed claims from 1,589,777 telemedicine visits that were submitted to Independence Blue Cross (Independence) from telemedicine-only providers and providers who traditionally deliver care in person. The primary exposure was the combination of individual behavior changes, state stay-at-home orders, and the Independence expansion of billing policies for telemedicine. The comparison population consisted of telemedicine visits in the prepandemic period. RESULTS: Telemedicine increased rapidly from a mean (SD) of 773 (155) weekly visits in prepandemic 2020 to 45,632 (19,937) weekly visits in the pandemic period. During the pandemic period, a greater proportion of telemedicine users were older, had Medicare Advantage insurance plans, had existing chronic conditions, or resided in predominantly non-Hispanic Black or African American Census tracts compared with during the prepandemic period. A significant increase in telemedicine claims containing a mental health-related diagnosis was observed. CONCLUSIONS: Telemedicine expanded rapidly during the COVID-19 pandemic across a broad range of clinical conditions and demographics. Although levels declined later in 2020, telemedicine utilization remained markedly higher than 2019 and 2018 levels. Trends suggest that telemedicine will likely play a key role in postpandemic care delivery.

The Role of Schedule Volatility in Home Health Nursing Turnover.

Despite considerable research on nursing turnover, few studies have considered turnover among nurses working in home health care. Using novel administrative data from one of the largest home health care organizations in the United States, this study examined turnover among home health nurses, focusing on the role of schedule volatility. We estimated separation rates among full-time and part-time registered nurses and licensed practical nurses and used daily visit logs to estimate schedule volatility, which was defined as the coefficient of variation of the number of daily visits in the prior four weeks. Between 2016 and 2019, the average annual separation rate of home health nurses was over 30%, with most separations occurring voluntarily. Schedule volatility and turnover were positively associated for full-time nurses, but not for part-time nurses. These results suggest that reducing schedule volatility for full-time nurses could mitigate nursing turnover in home health care.

The impact of the non-essential business closure policy on Covid-19 infection rates.

In response to the Covid-19 pandemic, many localities instituted non-essential business closure orders, keeping individuals categorized as essential workers at the frontlines while sending their non-essential counterparts home. We examine the extent to which being designated as an essential or non-essential worker impacts one's risk of being Covid-positive following the non-essential business closure order in Pennsylvania. We also assess the intrahousehold transmission risk experienced by their cohabiting family members and roommates. Using a difference-in-differences framework, we estimate that workers designated as essential have a 55% higher likelihood of being positive for Covid-19 than those classified as non-essential; in other words, non-essential workers experience a protective effect. While members of the health care and social assistance subsector contribute significantly to this overall effect, it is not completely driven by them. We also find evidence of intrahousehold transmission that differs in intensity by essential status. Dependents cohabiting with an essential worker have a 17% higher likelihood of being Covid-positive compared to those cohabiting with a non-essential worker. Roommates cohabiting with an essential worker experience a 38% increase in likelihood of being Covid-positive. Analysis of households with a Covid-positive member suggests that intrahousehold transmission is an important mechanism driving these effects.

Delayed emergencies: The composition and magnitude of non-respiratory emergency department visits during the COVID-19 pandemic.

IMPORTANCE: COVID-19 has been associated with excess mortality among patients not diagnosed with COVID-19, suggesting disruption of acute health care provision may play a role. OBJECTIVE: To determine the degree of declines in emergency department (ED) visits attributable to COVID-19 and determine whether these declines were concentrated among patients with fewer comorbidities and lower severity visits. DESIGN: We conducted a differences-in-differences analysis of all commercial health insurance claims for ED visits in the first 20 weeks of 2018, 2019, and 2020. The intervention period began March 9 (week 11) of 2020, following state stay-at-home orders. SETTING: We analyzed claims from Blue Cross Blue Shield of Louisiana (BCBSLA), located in a state with an early US COVID-19 outbreak. Visit and patient risk was assessed through comorbidities previously described as increasing the risk of COVID-19 decompensation, the hospital location's COVID-19 outbreak status, and the Ambulatory Care Sensitive Condition algorithm. PARTICIPANTS: The study population comprised all ED visits from all BCBSLA members, whether admitted or discharged. There were 332,917 ED visits over the study period. The study population spanned member demographics including sex, age, and geography. Uninsured adults were not included due to data limitations. EXPOSURES: The COVID-19 outbreak beginning March 9, 2020 in Louisiana. MAIN OUTCOMES AND MEASURES: The main outcome of interest for this analysis is the difference (percent change) in all ED visits, categorized as either respiratory or non-respiratory, from week 1-20 in 2019 and week 1-10 in 2020, compared to week 11-20 in 2020. RESULTS: In this differences-in-differences study using data from a commercial health insurer, we found that non-respiratory ED visits declined by 39%, whereas respiratory visits did not experience a significant decline. Visits that were potentially deferrable or from lower risk patient populations showed greater declines, but even high-risk patients and non-avoidable visits experienced large declines in non-respiratory ED visits. Non-respiratory ED visits declined by only 18% in areas experiencing COVID outbreak. CONCLUSIONS AND RELEVANCE: COVID-19 has resulted in significant avoidance of ED care, comprising a mix of deferrable and high severity care. Hospital and public health pronouncements should emphasize appropriate care seeking.

Model Homes: Evaluating Approaches to Patient-centered Medical Home Implementation.

BACKGROUND: The patient-centered medical home (PCMH) model has been widely adopted, but the evidence on its effectiveness remains mixed. One potential explanation for these mixed findings is variation in how the model is implemented by practices. OBJECTIVE: To identify the impact of different approaches to PCMH adoption on health care utilization in a long-term, geographically diverse sample of patients. DESIGN: Difference-in-differences evaluation of PCMH impact on cost and utilization. SUBJECTS: A total of 5,314,284 patient-year observations from the HealthCore Integrated Research Database, and 5943 practices which adopted the PCMH model in 14 states between 2011 and 2015. INTERVENTION: PCMH adoption, as defined by the National Committee for Quality Assurance. MEASUREMENTS: Six claims-based utilization measures, plus total health care expenditures. We employ hierarchical clustering to organize practices into groups based on their PCMH capabilities, then use generalized difference-in-differences models with practice or patient fixed effects to estimate the effect of PCMH recognition (overall and separately by the groups identified by the clustering algorithm) on utilization. RESULTS: PCMH adoption was associated with a >8% reduction in total expenditures. We find significant reductions in emergency department utilization and outpatient care, and both lab and imaging services. In our by-group results we find that while the reduction in outpatient care is significant across all 3 groups, the reduction in emergency department utilization is driven entirely by 1 group with enhanced electronic communications. CONCLUSION: The PCMH model has significant impact on patterns of health care utilization, especially when heterogeneity in implementation is accounted for in program evaluation.

Disruptions in preventive care: Mammograms during the COVID-19 pandemic.

OBJECTIVE: To measure the extent to which the provision of mammograms was impacted by the COVID-19 pandemic and surrounding guidelines. DATA SOURCES: De-identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms. STUDY DESIGN: We used a difference-in-differences approach to characterize the change in mammograms performed over time and a queueing formula to estimate the time to clear the queue of missed mammograms. DATA COLLECTION: We used data from the first 30 weeks of each year from 2018 to 2020. PRINCIPAL FINDINGS: Over the 20 weeks following March 11, 2020, the volume of screening mammograms and diagnostic mammograms fell by 58% and 38% of expected levels, on average. Lowest volumes were observed in week 15 (April 8 to 14), when screening and diagnostic mammograms fell by 99% and 74%, respectively. Volumes began to rebound in week 19 (May), with diagnostic mammograms reaching levels to similar to previous years' and screening mammograms remaining 14% below expectations. We estimate it will take a minimum of 22 weeks to clear the queue of missed mammograms in our study sample. CONCLUSIONS: The provision of mammograms has been significantly disrupted due to the COVID-19 pandemic.

Evaluating patient preferences for thermal ablation versus nonthermal, nontumescent varicose vein treatments.

OBJECTIVE: To measure patient preferences for attributes associated with thermal ablation and nonthermal, nontumescent varicose vein treatments. METHODS: Data were collected from an electronic patient preference survey taken by 70 adult participants (aged 20 years or older) at three Center for Vein Restoration clinics in New Jersey from July 19, 2019, through August 13, 2019. Survey participation was voluntary and anonymous (participation rate of 80.5% [70/87]). Patients were shown 10 consecutive screens that displayed three hypothetical treatment scenarios with different combinations of six attributes of interest and a none option. Choice-based conjoint analysis estimated the relative importance of different aspects of care, trade-offs between these aspects, and total satisfaction that respondents derived from different healthcare procedures. Market simulation analysis compared clusters of attributes mimicking thermal ablation and nonthermal, nontumescent treatments. RESULTS: Of the six attributes studied, out-of-pocket (OOP) expenditures were the most important to patients (37.2%), followed by postoperative discomfort (17.1%), risk of adverse events (16.3%), time to return to normal activity (11.0%), number of injections (10.0%), and number of visits (8.4%). Patients were willing to pay the most to avoid postoperative discomfort ($68.9) and risk of adverse events ($65.8). The market simulation analysis found that, regardless of the level of OOP spending, 60% to 80% of respondents favored attribute combinations corresponding with nonthermal, nontumescent procedures over thermal ablation, and that less than 1% of participants would forgo either treatment under no cost sharing. CONCLUSIONS: Patients are highly sensitive to OOP costs for minimally invasive varicose vein treatments. Market simulation analysis favored nonthermal, nontumescent procedures over thermal ablation.