Shared Decision-Making to Improve Patient Engagement in Minimally Invasive Hysterectomy.

Shared decision-making (SDM) between the patient and physician is receiving increased attention as a way to improve patient satisfaction and value of care. Having a readily implemented tool available to inform conversation may enable SDM at a high-volume gynecologic surgery practice. Our objective was to evaluate the impact of an SDM tool on patients' decision to have minimally invasive gynecology surgery. We conducted a feasibility study using the SDM tool plus a follow-up survey for 100 patients recommended to undergo minimally invasive hysterectomy. Nearly all patients (97%) indicated that they were satisfied with their decision to undergo a minimally invasive procedure, including laparoscopic total and supracervical hysterectomy with or without the aid of the robotic platform. Anecdotally, patients expressed appreciation for the provided materials and the presentation of care options. For the care provider, use of the SDM tool did not add substantial time to the visit. Knowing that comprehensive information was provided to all patients was reassuring. Implementing a shared decision-making model in a gynecological practice is feasible and increases awareness and engagement, as well as satisfaction, among patients electing to have a hysterectomy.

Bariatric Surgery Coverage: a Comprehensive Budget Impact Analysis from a Payer Perspective.

OBJECTIVE: The objective of this study was to estimate a payer's budget impact of bariatric surgery coverage under (1) unrestricted, (2) budget-restricted ($500,000/year), and (3) quantity-restricted (100/year) medical benefit plan scenarios versus non-coverage in general and type 2 diabetes mellitus (T2DM) populations over a 10-year period. METHODS: Using recently published literature and health technology assessment reports, the model evaluated a hypothetical payer population of 100,000 members under current real-world trends: BMI-defined obesity groups (31.3% normal/underweight, 33% overweight, 20.4% obese, 9% severely obese and 6.3% morbidly obese), T2DM prevalence (6.7-27.5%; 100% for the T2DM model), surgery type (LAGB, BPD/DS, VSG, and RYGB), and differential outcomes (T2DM resolution, costs, and reoperation and complications rates). Assuming a surgery election rate of 1.42% among eligible candidates with a 3% discount rate and 10% annual surgery turnover rate, the model calculated the incremental cost per-member-per-month (PMPM) by estimating the difference in total non-T2DM and T2DM-related expected costs and savings. One-way (± 25%) sensitivity analysis was performed. RESULTS: The impact of covering bariatric surgery under multiple scenarios for a general (or T2DM) population ranged from an additional $0.3 to $3.6 (T2DM: $0.3 to $10.5) PMPM in year 1. Incremental costs diminished over time, breaking even between years 5 and 9 (T2DM: 5-6), and by year 10, cost savings were estimated to be between $1.5 and $4.8 (T2DM: $1.2 and $31.8). CONCLUSION: Providing bariatric surgery coverage may have a modest short-term budget impact increase but would lead to long-term net cost savings in a general population model. The cost savings were much more pronounced in the T2DM model.