Patient Perspectives on Alternative Payment Models in Plastic Surgery

Alternative payment models (APMs) promote high-value care by linking cost and quality. This is the first study to evaluate plastic surgery patients' perception of APMs, assessing patient priorities and how brief education on payment models alters patient values.

Study participants of 18 y or older who underwent a plastic surgery procedure from 2013 to 2023 were identified through an institutional database. Eligible participants were surveyed on baseline APM knowledge and attitudes toward provider and institution attributes. A brief educational excerpt on APMs was provided, followed by a posteducation survey.

Of 2183 patients contacted, 264 (12.1%) completed all surveys. Baseline APM awareness was low (7.6%). Pre-education priorities included hospital affiliation (87%), patient testimonials (76%), transparent cost breakdown (70%), and revision costs (69%). After education, respondents cared more about surgery cost (29%-47%; P < 0.001), complication rate (73%-87%; P < 0.001), revision policy/costs (48%-70%, P < 0.001), surgeon's compensation model (18%-46%, P < 0.001), and explanation of their surgeon's compensation (30%-44%; P = 0.02). They grew more hesitant to undergo surgery with APM-paid surgeons (13%-38%, P = 0.023), and fewer supported incentivizing physicians to minimize cost while maintaining outcomes (64%-53%, P = 0.006).

Plastic surgery patients have limited baseline knowledge of health-care payment models. Upon education, patients tend to care more about transparency regarding costs, complications, and compensation models, with greater hesitancy regarding payment models that incentivize cost minimization. Understanding patient decision-making priorities and perspectives will be key to ensure the delivery of high-value care without compromising patient confidence.