Patients are facing increasing out-of-pocket healthcare costs and, subsequently, independent physicians are seeing an increased need to discuss the cost of care with their patients. It has been estimated that approximately one-fourth of all patients in the US have trouble paying their medical bills. In addition, research has found that increased out-of-pocket expenses are associated with lower adherence, delayed or missed care, and higher mortality, so a discussion about costs could be critical for better outcomes.
An article published in the Annals of Internal Medicine by Dr. Caroline Sloan of Duke University Hospital and Dr. Peter Ubel of the Fuqua School of Business discusses the need to engage patients more fully regarding the costs of their care, to reduce the financial barriers as well as surprises that patients sometimes receive with their healthcare bills. Dr. Sloan and Dr. Ubel suggest seven strategies to effectively discussing the cost of care with patients:
- Ask patients about potential financial hardships. A study of internists found that most relied on clues from their patients that would hint at their struggles with the cost of their care. Physicians should be more proactive in their discussions with patients regarding their ability to pay, rather than waiting to find out a patient is not taking prescribed medications or following care directions because they are too expensive.
- Discuss costs. Just as physicians discuss diagnoses and prognostic information, they must keep patients informed about their financial prognoses to enable those patients to anticipate their out-of-pocket expenses.
- Anticipate and help patients plan for costs. Direct costs such as medications, diagnostic tests, and procedures can be expensive, but most patients are concerned about the indirect costs of office visits, such as lost income, transportation, and child care. When discussing the costs of care with patients, these costs should be anticipated and planned for as well.
- Explore out-of-pocket costs routinely. Physicians and patients will become more comfortable with discussions related to financial issues when those conversations are held more routinely. In one study cited by the authors, patients perceived an increase in cost-of-care conversations (44% to 65%) and a reduction in cost concerns (53% to 36%) when the conversation was incorporated as a routine part of the office visit.
- Integrate conversations about the cost of care into your workflow. The authors suggest three strategies for more smoothly integrating the cost conversation into the independent practice’s workflow:
- Give one person the role of out-of-pocket cost problem-solver, so they can develop expertise and efficiency
- Use the electronic health record (EHR) to document patients’ financial needs
- Use the EHR to gather data on costs and/or insurance coverage, when available.
- Enlist the assistance of clinical staff. Ancillary staff can aid in incorporating cost of care conversations into the practice’s workflow as they have more flexibility and are probably better able to relate to the patients’ financial situations.
- Include conversations more consistently. Studies have shown that physicians who continue to have cost of care discussions with patients continue to get better at them. In addition, those independent physicians who include these conversations in their patient visits take costs into account more often when they are making medical decisions for those patients.