Do physicians dismiss patients’ financial concerns?
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.