Do physicians dismiss patients’ financial concerns?


Patients need cost information to make the best treatment decisions. But physicians are coming up short.

With access to information about the costs of care, patients can make better choices about treatment paths that are aligned with their financial goals. Absent that information-or conversations with their physicians about costs-it’s virtually impossible for patients to incorporate this information into their decision-making.

Herein lies the problem: When physicians don’t talk to their patients about the cost of the care they receive, patients who are blindsided by medical bills may stop showing up for appointments, stop taking medications, and/or decide against pursuing their recommended treatment plans, which reduces the cost of care in the short term but can result in higher costs-for payers, providers, and patients-in the long term.

“We as physicians are trained to try to help patients weigh pros and cons [associated with treatment paths], but we don’t do that well when it comes to costs,” says Peter Ubel, MD, professor of business administration and medicine at Duke University. “Take an ultrasound, for example. A lot of [physicians] think, ‘What’s the downside? It’s a non-invasive test. I’ll just [order an ultrasound] and check the results.’”

What physicians often forget is that the cost of that ultrasound-which could be as much as $500-can “invade our patients’ wallets,” he says.

Go-to strategies aren’t working

Ubel dove deeper into this topic for a study published in Health Affairs in 2016. After analyzing 1,775 clinical interactions between physicians and patients, Ubel and his research team found that physicians typically demonstrated two types of behavior when patients brought up financial concerns about the cost of care:

  • They were dismissive of such concerns from patients; or,

  • They were uncertain about discussing patients’ out-of-pocket costs or leaned on short-term solutions-such as 14-day discount cards for a prescription drug or free samples that happened to be in the office-rather than discussing treatment alternatives aligned with patients’ financial concerns.

Ubel and the researchers focused on encounters between patients and their physicians regarding breast cancer, depression, and rheumatoid arthritis. These conditions were chosen because they often require expensive treatments that can lead to high out-of-pocket costs.

Next: Root of the problem



Root of the problem

One reason physicians don’t discuss out-of-pocket costs as much as they should is because they’re busy, says Ubel. But focusing on treating a condition without discussing costs can have serious implications. Take diabetes, for example, he says. If a physician wants his or her patient to try a new medication to lower their blood sugar, and the physician hasn’t taken the time to screen for the patient’s financial concerns, the patient may stop taking the medication or not fill the prescription.

Ubel says that, while doctors might assume they know what’s medically best, they need to become comfortable talking to patients about what might be “medically second best or good enough.” This conversation could be the difference between a patient opting for treatment, or not getting treatment at all.

No longer an option

Cost-related conversations between physicians and patients are essential because there’s a “national spotlight on cost transparency,” says Robin Gelburd, president of FAIR Health. In a departure from the past when only payers and employers needed to focus on the cost of care, consumers are being “plucked from the chorus line” and put “in a starring role” in terms of their treatment expenses, she says.

Currently, most patients only discover the cost of care when they receive a bill. These bills are always a surprise, says Gelburd, who insists that if consumers have access to the cost of care in advance they will file fewer complaints and express a greater level of satisfaction with the clinical aspects of their care.

Plus, it’s in physicians’ best interest to educate patients about the cost of care, she says. “If patients can’t pay for the care they receive, providers might not be able to collect on balance bills.”

Tools that can help

So now that the necessity is established, how can physicians begin incorporating cost into patient conversations? Here are some tips:

1. Use technology to your advantage. Hard-coding information into the electronic health record (EHR) about prescription drugs and procedure costs can make it easier, says Ubel. That’s because physicians typically have access to the EHR during patient visits.

2. Ask the right questions. Physicians also need to find a way to screen for financial distress. Ubel recommends that physicians ask patients, “Do you want to talk about healthcare expenses?”

3. Refer patients to helpful resources. Gelburd reinforces that physicians don’t need to be experts in patients’ out-of-pocket costs, but they can refer patients to resources that are written in patient-friendly language. For example, FAIR Health’s consumer-facing website,, provides data on billions of billed medical and dental services.

“Nothing makes a patient angrier than receiving a $500 bill they didn’t expect. They get very upset because no one told them,” says Richard L. Gundling, senior vice president of healthcare financial practices at the Healthcare Financial Management Association (HFMA), a nonprofit for healthcare financial management executives. In addition to suggesting that patients contact their insurance company to learn about the cost of a particular procedure, Gundling also recommends that physicians refer patients to “Understanding Healthcare Prices: A Consumer Guide,” which was developed by HFMA.

4. Rely more on payers for information. Ubel encourages payers to provide more comprehensive information to providers and patients about the true cost of care. “That’s part of the insurance company’s role,” he says. Not only that, it’s in payers’ best interest to provide cost information to patients, especially to those with high-deductible plans, he says. “That saves [payers] money.”

Aine Cryts is a writer based in Boston.

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