Some may hesitate to talk about financial issues with a doctor, while others want to spare no expense for their care.
By Karen Caffarini — Posted April 8, 2013.
With health care costs and patient deductibles rising, physicians are discovering that cost is an integral part of the conversation with patients during an office visit.
Studies have shown that patients and doctors want to engage in such discussions, despite worries about potential awkwardness. Physician advocates and medical societies say these conversations could lead to lower costs for patients without lessening the standard of care.
How a practice brings patients into this conversation is important. Surveys have found that some patients are hesitant to talk about their finances to a doctor, and others demand the gold standard of care for themselves, believing anything less expensive is less effective.
Susan Dorr Goold, MD, a professor of internal medicine at the University of Michigan Medical School, helped survey more than 200 insured people in 2011. The study asked participants to imagine themselves with various symptoms and a choice of treatments that vary slightly in effectiveness but significantly in cost. Most patients wanted the most expensive option for themselves, Dr. Dorr Goold said. Some wanted to “get back at” insurance companies for the high costs they pay in insurance.
“One of the things we found is more expensive always means better to many patients when it comes to their own health care, even though that’s not always true,” Dr. Dorr Goold said.
Talking about prices is gaining traction
Medical societies and other physician organizations are encouraging cost reduction and conversation, pointing out that U.S. health care accounts for 17.6% of the gross domestic product, making it a burden for government, businesses, families and individuals. Plus, $750 billion a year is spent on tests and procedures that don’t make patients any better.
At the American Medical Association Annual Meeting in June 2012, delegates approved a report by the AMA Council on Ethical and Judicial Affairs that says wise stewardship of limited health resources is an ethical obligation for physicians. The report also said patients and their families can be involved in decision-making, with the case for a less-expensive, but equally effective, treatment spelled out for them.
Meanwhile, more than 36 specialty societies are now part of Choosing Wisely, an initiative that encourages doctors and patients to talk about treatments and procedures that may not be necessary and may, in some instances, cause harm in the long run. Glen Stream, MD, board chair of American Academy of Family Physicians, said that although the main goal of Choosing Wisely is better medical practice, cost is a positive byproduct.
In 2009, Neel Shah, MD, an obstetrician-gynecologist, started Costs of Care, a nonprofit in Boston that aims to transform health care delivery by empowering patients and physicians to reduce medical bills by rejecting or replacing costly procedures that don’t improve health.
“It seemed crazy to me at the time that we didn’t talk about cost,” said Dr. Shah, executive director of Costs of Care. “I’m finding that this is patient-driven. Patients want this information, because they’re taking the first couple thousand of dollars in medical costs on the chin.”
Steps to starting a dialogue
Dr. Stream said doctors need to have their patients’ trust, which will help when recommending a specialist the patient has never seen. “I tell the patient, ‘I have faith and confidence the specialist will help us take the best care of you,’ ” he said.
Speak to patients in nontechnical language, Dr. Stream said. When refusing to do a certain test or procedure, provide the patient with literature on the subject or read it together at the Choosing Wisely website, he said.
Source: http://www.amednews.com/article/20130408/business/130409951/5/
