For many years, patient care and medical expenses have been separate discussions: medical care discussions were between doctors and patients while cost conversations were between providers and insurance companies. But now that a new paradigm in health insurance has emerged that shifts more of the financial responsibility for care to patients and families, consumers are taking note of the costs of care. Consumer directed health plans and other high-deductible health plans are making the cost question an imperative, especially since U.S. census data reports median gross household income at $50,000.
Although many doctors have taken note of the high number of patients that question the cost of a procedure, test or prescription, it still is an ad hoc conversation. Just yesterday I had a story relayed to me by a neighbor who had taken her son to the dermatologist for acne. The doctor wrote a script for Doryx– no one discussed price. She went to the pharmacy and left the prescription with the pharmacist – no price discussion. However, when she went to pick up the 30-day supply the bill was $400. She was incredulous that no one bothered to tell her beforehand. And it never occurred to her that acne medicine would be this expensive so she didn’t ask. When she called the dermatologist’s office to complain and ask for a different prescription she was told a generic equivalent doxycycline was available, but that it would need to be taken twice a day instead of 1x. The cost was $20, certainly enough of a price differential to accept the 2x/day dosing schedule.
So who is responsible for initiating the cost discussion – the patient or the provider? With bad debt rising for providers, it would seem to be in the best interest of providers to take this on as routine, but it also presupposes that costs are available to providers as they’re sorting out treatment options. In addition, it requires providers to look at medical services through the lens of financial burden and affordability, which is not the way our physicians are trained.
Asking patients to take full responsibility for the cost discussion assumes that all patients feel the personal authority to ask a question that can feel like a challenge to an expert’s credibility. Patients who are less educated and feel less empowered are at an increasing disadvantage when it comes to high engagement with medical providers. Often, they become passive, non-compliant patients. However, since consumers are ultimately responsible for their portion of the bill, it’s no longer an option to avoid the cost conversation and accept all levels of care without knowing the price tag attached to it.
One solution to better managing care and costs is to increase consumer education regarding patient choices, and how to make decisions about care, such as what we offer at myhealthandmoney.com. This will require more than one solution to account for age, ethnicity, language and educational level differences. It will need to show patients how to work with their providers to identify the right treatment choice for them – one that meets personal criteria for quality and affordability.
Another solution is to bring pricing out from behind everyone’s wall. Carriers consider allowables their intellectual property so they don’t want to share pricing information. And most hospitals don’t publish charges. Also, when you call the hospital billing department they don’t want to give you the information. Only Medicare publishes rates by DRG and has created a consumer-friendly Medicare.gov website to compare prices. If pricing transparency is essential to lowering costs, then those owning the data need to be willing to share it more openly.
The care and cost conversation needs to be owned by both patients and providers with support from institutions that have pricing data. Consumer engagement and purchasing savvy will help to make patients better partners with providers while considering affordability in all treatment decisions will help providers better partner with patients.
