Time From Booking Until Appointment and Healthcare Utilization in Hand Surgery Patients With Discretionary Conditions

Abstract

Delaying medical therapy for benign musculoskeletal conditions may allow patients to develop coping strategies, resulting in less need for medical intervention and reduced cost. Our primary question was whether time from booking until appointment is associated with healthcare costs. Our secondary question was whether time from booking to appointment is associated with healthcare utilizations, including imaging, injections, nerve conduction studies, occupational therapy visits, surgery, referrals, and second opinions. We identified 16,750 patients making a first clinic visit to a hand surgery practice from 2003 through 2012. Utilizations were determined until the patient’s second visit. Costs were determined in Relative Value Units. In multivariable models, duration between booking and office visit was not associated with higher cost. Duration between booking and office visit was associated with a higher rate of nerve conduction studies (P < 0.001) and a lower rate of occupational therapy (P < 0.001). We observed substantial variation in cost and utilization based on treating surgeon. In a setting with relatively short wait times, greater wait time was not therapeutic, but is associated with different diagnostic and treatment measures. The variations by surgeon may make variations based on other factors including time between booking and appointment difficult to discern.