The dollars and cents of medical care have long been shrouded in mystery, but renewed efforts by government leaders and consumer groups are compelling more physicians to bring up the issue of cost. A poll conducted by Public Agenda found that almost 70 percent of Americans would like for their doctor to discuss cost with them. In part, this has been sparked by the national debate surrounding health care reform and the continual rise in out of pocket expenses, but it is also being fueled by strengthening consumer activism that empowers patients to shop around.
Most medical providers are unwilling to broach the issue of treatment costs, perhaps out of deference to the medical ethic to provide the best care possible regardless of the price tag. While this idealistic approach to care has noble intentions, it is often a disservice to patients who may have to choose treatment options based on cost. A Kaiser Family Foundation study reports that 42 percent of patients have some or extreme difficulty paying for health services.
These cost of care discussions do more than inform medical consumers; in some cases, they assist in producing better patient outcomes. In one study performed by Dr. Nora Henrikson, patients who were more informed about cancer treatment costs enjoyed better outcomes. A better understanding of upcoming expenses helped patients plan accordingly and avoid serious financial complications. This greater emotional stability translates into more positive health outcomes for cancer patients.
Financial Realities
One of the most important drivers of the new movement for price transparency is the rising price of health care coupled with diminishing coverage. Whether consumers are insured through their employer or private plans like those found on the ACA health insurance exchanges, there is an undeniable trend within the market to raise premiums and deductibles. In 2006, only ten percent of employer health plans had an annual deductible of $1,000 or more; in 2015, more than 63 percent have deductibles of at least $1,000.
The growing burden upon consumers is forcing many to bring up the issue of cost with physicians. While the prevalence of cost of care discussions is consumer driven, more physicians also want to bring up price issues. However, the complexity of the health care pricing system is impeding many physicians from taking the initiative. Physicians would have to familiarize themselves with patient insurance policies—including their level of coverage and financial responsibility—as well as the current costs of many treatments.
Few physicians are willing to take on the herculean task of memorizing treatment costs according to health plan and payer, so most are left to conducting cost of care discussions in only the most general terms. Although most providers are compassionate about the financial situation of patients, they rarely have the time and resources to accommodate these conversations, leaving most patients to make independent inquiries through insurers or front offices.
However, the growing recognition that pricing is integral to patient outcomes has spurred organizations to investigate new conversational models. The Robert Wood Johnson Foundation has sponsored new projects that integrate cost of care discussions into clinical protocols. The ultimate goals of these and similar initiatives is to produce standards and best practices for pricing transparency discussions.
Article written by:
Dr. Robert Moghim, CEO Moghim Medical Consulting Inc.