Physicians often relied on their own professional experience to anticipate what treatments might be most expensive, and clinicians are usually aware that patients may be making financial trade-offs to afford care, Dr Perez and colleagues note. Interviews and Survey There were 2 components to the study designed by Dr Perez and colleagues.
Full Answer
Why should physicians talk about cost with patients?
It’s important to understand the cost of care since it impacts treatment options. The cost of health care in the United States remains a challenging puzzle for patients and providers. Absent of clear, easy-to-understand pricing guidelines that span across state lines, many struggle to determine the actual price of a medical procedure.
Do doctors get paid for healthcare treatment?
· What’s interesting is that out of that $2.9 trillion, only 16.1 percent went to physician services. Moreover, physicians are part of the reason that spending is at historically low growth levels. Physician spending grew more slowly over the 2003-2013 period than hospital spending, clinical spending and total personal health spending.
How can we make healthcare more affordable for patients?
· Set the vision. Work with executive and physician leadership to define what the organization hopes to learn from physician cost data and what are its “need-to-know” priorities. Map the approach. Sketch out an initial process for physician costing, including any assumptions regarding physicians’ roles in the process.
Why should you care about health care costs?
Among the 109 physicians who completed both pre- and post-intervention surveys, respondents after the intervention were more likely to report asking their patients about out-of-pocket drug costs (22% before vs 27% after; P < .01) and less likely to feel unaware of drug costs (78% before vs 72% after; P = .02; Table 2).
How do doctors learn about new treatments?
The most common sources for neurologists included journal articles, direct mail from drug companies, and pharmaceutical representatives, whereas family practice physicians most often reviewed email summaries provided by professional society listservs or subscription services.
Do doctors have to tell you how much something costs?
Physicians must start talking prices with patients To help realize the promise of consumer-driven health care — in which sharing financial risk causes consumers to spend health care dollars more judiciously — physicians and other health professionals must start talking about cost with their patients.
Who should explain the costs of their care to a patient?
The physician is often the best person to initiate the cost discussion, says Zafar, because they are responsible for the treatment plan. But other team members can sometimes help as well.
Should doctors consider cost when treating a patient?
The rising cost of medicines may be a growing problem for many Americans, but a new survey finds that cost is generally not a key factor when doctors decide which treatments to prescribe their patients.
Why don't doctors tell you prices?
Here the answer is clear: the medical insurance companies. You've gotten those bills where the doctor charges this amount and the insurance has adjusted it, saying we'll only pay this amount for that service. So, the doctor has to accept the payment. So, the doctor doesn't discuss price with you.
What is costing in healthcare?
To patients, cost usually represents the amount they have to pay out-of-pocket for health care services. This cost is very different from the amount that providers (i.e., health care organizations or clinicians) incur to deliver that service.
What is cost of care in healthcare?
When healthcare experts talk about the Total Cost of Care, they are most often referring to the total cost of a population and what it costs to care for them medically. Total Cost of Care should be limited to the costs that are incurred to be able to provide care.
How do physicians who are PCP's contribute to the control of health care costs?
The goal of managed care is to provide good care while practicing efficiency and controlling costs. It rewards health care providers who prescribe the most services. How do physicians who are PCPs contribute to the control of health care costs? Health care costs are evenly distributed among all patients.
How much was the national health care budget in 2013?
In 2013, the last year for which data are available, national health expenditures were more than $2.9 trillion —that breaks down to $9,255 per person. This reflects growth of only 3.6 percent over the previous year—the lowest annual growth rate since 1961, the first year the current framework for spending was used.
Is acute care preventable?
But acute care often is preventable. That’s why my clinic seeks to keep our patients out of the hospital. Through an aggressive approach to managing cancer treatments and its side effects, we keep our patients as healthy as possible, minimizing emergency room visits and hospitalizations.
How to start a physician cost plan?
It is nonetheless important to start with a plan, which includes the following steps: Set the vision. Work with executive and physician leadership to define what the organization hopes to learn from physician cost data and what are its “need-to-know” priorities. Map the approach.
What is physician analysis?
Physician analysis, by providing comparative physician data on costs and utilization and identifying areas for executive and managerial focus on unwarranted variations in care and cost reduction opportunities. Pricing and contracting, by informing negotiations that secure payments sufficient to ensure full cost coverage.
What is lack of actionable cost data?
A lack of actionable cost data is a particularly acute problem with respect to physician costs. Costs associated with the physician enterprise are a significant driver of patient care costs and service- line profitability, and health systems’ need for accurate and trusted physician cost data has only intensified.
Is physician costing a work in progress?
The addition of physician costing to existing hospital-based costing processes should be approached as a work in progress: Physician cost data can be refined gradually to improve the data’s specificity and value as a decision-making tool . It is nonetheless important to start with a plan, which includes the following steps:
What is it like to go to the doctor?
Going to the doctor in the United States is like dining at a restaurant where the menus don’t list prices. At this restaurant, the chef decides what you should eat, and someone else entirely calculates the bill. The chef is considered an artist unencumbered by financial details so he or she can focus on preparing the best food possible. Yet with no consideration of cost, the chef decisions could result in a surprising and shocking bill that you cannot afford and which potentially goes unpaid, bankrupting the restaurant in the process.
Who has responsibility to talk to patients about the cost of care?
Physicians have responsibility to patients to talk about the cost of care, prescriptions. Health care providers must acknowledge patients’ financial concerns. The path forward requires cultural changes that normalize cost conversations. Deb Gordon. Opinion contributor.
Do medical students have cost conversations?
I recently met with a group of medical students also pursuing public policy degrees. They told me that they have rarely initiated cost conversations with patients in their clinical training, and that they generally feel somewhat or extremely uncomfortable discussing costs with patients. Their training in this area is informal, based more on observation than structured curriculum. This gap needs to close. And it can, with deliberate training and use of tools and technology to make costs easier to access.
Why do cancer patients not take their medications?
Another recent study showed that even cancer patients do not necessarily take their medications as prescribed — or at all — due to financial barriers. Approximately 30 percent of people diagnosed with cancer in this study asked a doctor to prescribe a lower-cost medication.
Is Medicare for all the answer?
More: 'Medicare for All' isn't the answer. We need a basic health care safety net for all.
What is cost based on?
Costs are based on each patient’s insurance plan, whether the patient has and has met a deductible, what codes will be used to bill the service, and what charges the health plan allows. Not surprisingly, these conversations rarely happen.
How to help realize the promise of consumer-driven health care?
To help realize the promise of consumer-driven health care — in which sharing financial risk causes consumers to spend health care dollars more judiciously — physicians and other health professionals must start talking about cost with their patients. The path forward will likely require long-term cultural changes that normalize cost conversations; we should start this journey by training clinicians on why and how to engage with patients about health care costs.
How to engage physicians in cost reduction efforts?
Based on this survey and other literature about physicians’ perceptions of their role and their ability to control costs, it is clear that the first step in understanding how to engage physicians in cost-reducing efforts is to understand what the drivers are for utilization and what the concerns are for reducing cost . Many hypothesize that the drivers to support the status quo include a fear of litigation, fear of missing a diagnosis, and patient demands for services. Another major driver of current utilization is that there is ongoing support for the status quo, as the majority of reimbursement for providers is still based on fee-for-service.
How many physicians agree that they need to reduce unnecessary testing?
Almost all physicians agreed that they need to reduce unnecessary testing (97%), need to adhere to guidelines (98%), and have a responsibility to control costs (92%). However, 33% felt it was unfair for them to have to be both cost-conscious and concerned with the welfare of their patients.
What is malpractice reform?
Malpractice reform to support physicians trying to balance cost consciousness with patient welfare
How many physicians feel pressure to refer patients?
More than half of physicians felt pressure from patients to perform tests and procedures (from 68% of primary-care physicians, 58% of medical specialists, and 56% of surgical specialists) and felt pressure to refer to consultants (from 65% of primary-care physicians, 35% of medical specialists, and 34% of surgical specialists).
Do physicians know what their cost drivers are?
A recent survey of a large physician group practice found that many physicians do not know what their cost drivers are or do not think it is their role to participate in cost-reduction efforts.1 Of note, the group practice in the survey is a Pioneer Medicare accountable care organization (ACO) and participates in a combination of fee-for-service and capitated contracts.
Is healthcare in a financial pinch?
Regardless of the actual numbers, all healthcare institutions are feeling the financial pinch. Most are intensely focused on cost-reduction efforts. The question is, what do physicians think about their role in these efforts, and what efforts will be most effective?
Is healthcare under stress?
The healthcare industry is under major stress from steady declines in all sources of revenue. The drivers are multifactorial but include declining reimbursement from payors, a shift from fee-for-service to pay-for-performance, and state-by-state variability in patients covered by Medicaid, by high-deductible plans, or by being uninsured. In academic medical centers, rising overhead costs coupled with a reticence to raise student tuition and declining research funding streams have further compounded the situation.
What is pay for performance?
A pay-for-performance model where the physician’s training, skills and time expended to provide a given service are taken into account when establishing compensation. With this model, the actual care provided by the physician is the driving force of compensation more so than the number of visits.
What is concierge medicine?
An alternative to traditional payment models, where medical practices have a direct financial relationship with patients. They typically charge a monthly or annual fee so that the patient receives additional access and personalized care. These practices are known by a variety of names: concierge healthcare, direct primary care, direct care, direct practice medicine, retainer-based, membership medicine, cash-only medicine, cash-only practice, boutique medicine, personalized healthcare.
How long does a physical exam last?
For example, the patient may receive 24-hour physician availability by having the doctor’s phone number and email, as well as telephone consultations; executive-type physical examinations that last up to three hours long; expedited appointments, such as same-day or next-day appointments and no wait time at the office visit; longer appointments, personal visits in the hospital and sometimes in-home visits; follow-up calls after a specialist referral and/or hospital stay; and customized treatment plans including lifestyle and preventive plans.
What are the benefits of a payment model?
The primary benefit of this payment model is that without the constraint of fee codes, healthcare providers are given increased flexibility in deciding what the patient requires and the needed resources to deliver them. However, as a physician, the concern lies in how administrators manage under such a payment system.
How many models of bundled payments are there?
With bundled payments, there are four models:
Should capitation be balanced?
Given that the majority of people enrolled in a health plan will never use health care services within any given month, capitation arrangements should naturally balance out the high utilizers in health plans with those who use little or no health care every month.
Is fee for service reimbursement going out?
Fee-for-service reimbursement is potentially on its way out, which means more complex payment models are continuing to emerge.
How long does a doctor spend with each patient?
In 2018 its physicians spent, on average, 189 minutes with each patient, compared with an average of only 20.9 minutes for all U.S. primary-care doctors.
How does a new primary care model help?
A new primary-care model can lower costs and improve outcomes.
Is leveraged primary care cost effective?
The leveraged-primary-care model isn’t only cost-effective. Consider some of its successes in addressing these life-threatening, expensive diseases:
Can pharmacists access laboratory data?
Added recently to the model, pharmacists can access laboratory data and, using protocols created by the physicians, make many of the medication changes needed, saving doctors even more time.
How does a medical assistant work at KP?
At KP each primary-care doctor is assigned a medical assistant. By communicating with the patient, reviewing information, readying it for the physician, relaying physician orders, and arranging transportation through community services, medical assistants help physicians manage patients’ chronic diseases better— and at a small fraction of the cost of other approaches. They save doctors enormous amounts of time—just extracting all the data from electronic health records, assembling it, and organizing patients’ clinical information could take several hours a day. While their pay varies by geography and union agreements, assistants make $40,000 to $50,000 a year, roughly half what registered nurses or nurse practitioners earn. Their training takes a year and is offered by community colleges, state colleges, and vocational schools.
What is the EHR system?
One is a comprehensive EHR system that provides physicians up-to-date information on each patient’s condition, highlighting the need for additional treatments or testing. The system makes it easy for the physician and support staff to quickly order tests, change medications, send messages to patients, and monitor clinical results. It can also be used to find and prioritize individuals with chronic diseases who need attention before a routine visit. A second type is wearable devices that record data on blood pressure and weight. A third is computer-generated voice and text messages that remind patients about preventive screenings. And a fourth is a smartphone video function that allows doctors to monitor patients after they leave the hospital, immediately address new medical problems, and avoid readmissions.
How do disease management companies work?
Disease-management companies typically organize nurses and social workers into teams that focus on just one disease, which means that patients with several chronic illnesses could be dealing with multiple teams. These interactions occur outside the primary-care physician’s practice and often duplicate its work: Both the teams and the physicians monitor each patient’s laboratory results, medications, and overall health. Most patients like the convenience of disease-management programs, which they can call on for help navigating the complex care-delivery system, scheduling visits with doctors, arranging transportation, and connecting with social services. Many also take advantage of the educational opportunities and coaching that such programs provide. But the dollars the programs consume could be better used to address the needs of far more individuals.
