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Financial Toxicity in Cleft Lip and Palate Repair: Trending the Cost Burden For Commercially-Insured Patients
Danielle H. Rochlin MD1, Clifford C. Sheckter MD1,2, H. Peter Lorenz MD1 1Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA 2Division of Plastic Surgery, University of Washington, Seattle, WA

Background: As healthcare spending within the United States continues to grow, payers have attempted to curb spending through higher cost-sharing for patients. For families attempting to balance their financial obligations with their children's surgical needs, high cost-sharing could place families in difficult situations deciding between life-altering surgery and bankruptcy. We aim to investigate trends in patient cost-sharing and provider payments for cleft lip and palate repair.

Methods: The IBM MarketScan national commercial claims databases were queried to extract patients younger than age 18 years who underwent primary or secondary cleft lip and/or palate repair from 2007 to 2016 based on CPT code. Financial variables recorded included gross payments to the provider (facility and/or physician), net payment as reported by the carrier, coordination of benefits and other savings, and the beneficiary contribution, which consisted of patients' coinsurance, copay, and deductible payments. Linear regression was used to evaluate trends in payments over time. Poisson regression was additionally utilized to trend the proportion of patients with a non-zero beneficiary contribution. All financial values were adjusted to 2016 dollars per the consumer price index to account for inflation.

Results: The sample included 6,268 cleft lip and 9,118 cleft palate repair episodes. Total provider payments increased significantly from 2007 to 2016 for patients undergoing cleft lip (median $2,527.33 vs. $5,116.30; p=0.008) and palate ($1,766.13 vs. $3,511.70; p<0.001) repair. Beneficiary contribution additionally increased significantly over the study period for both cleft lip ($155.75 vs. $193.31; p<0.001) and palate ($124.37 vs. $183.22; p<0.001) repair, driven by an increase in deductibles (p<0.002). For patients undergoing cleft palate repair, the proportion with a non-zero beneficiary contribution increased by 1.6% per year (p=0.002). Higher provider payments and beneficiary contributions were found in the Northeast (p<0.001) and South (p<0.011), respectively, for both cleft lip and palate repair.

Conclusion: United States national data demonstrate that for commercially-insured patients with cleft lip and/or palate, there has been a trend toward higher patient cost-sharing that is most pronounced in the South. This suggests that patients are bearing an increased cost burden at the same time that provider payments are accelerating. Additional studies are needed to understand the impact of increased cost-sharing on parents' decision to pursue cleft lip and/or palate repair for their children.


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