Physicians and Cost Conversations
Researcher Susan Perez has conducted enough interviews and focus groups to know that patients often want to talk with their physician or other clinicians about the cost of medical care but don’t know how to broach the topic.
In addition, she said, many patients are reluctant to ask about costs because of limited time with the provider or the belief that it is not the doctor’s responsibility to talk about costs. There is also a lack of awareness among patients that it’s okay to discuss costs with their physicians, she said.
“Many people worry that voicing concerns about costs might alienate doctors or result in lower quality care,” said Perez, who has conducted several research studies on how to have cost conversations and on how consumers make health care decisions, with the aim of empowering patients to ask about costs.
But Perez has been equally interested in physician attitudes about cost conversations, noting that the attitudes of physicians toward cost conversation would impact the success or failure of such discussions.
“Whatever we learn from consumers, we need to understand the other side. We wouldn’t want to send patients in with all these empowering messages and have someone who might not be receptive or even able to follow through,” said Perez. “We wouldn’t want to create conflict.”
With coordination and support from the American College of Physicians (ACP) and the Robert Wood Johnson Foundation, Perez has conducted research to assess physician attitudes about cost conversations through 20 physician interviews in September 2017 and a nationwide survey of ACP physicians specializing in general internal medicine or an internal medicine subspecialty. She said the one-on-one telephone interviews helped shape and inform the survey questions; more than 600 internists completed the survey, launched in December 2017.
For the interviews, Perez used a facilitator’s guide developed in consultation with two clinicians, two health consumer advocates, and a health services researcher. The guide inquired about physician workload and incorporated themes and common experiences shared from patient focus groups.
In analyzing results from patient focus groups and the physician survey, Perez and her team identified clear alignment in attitudes about the importance and benefits of patients and physicians discussing health care costs. Perez said that in an ironic twist, patients and physicians both agreed that costs should be discussed and that the other should be the one to bring up the topics.
Other findings from her patient and physician research include:
- Patients felt empowered to address the topic when provided with resources to engage in cost conversations, such as the Choosing Wisely “5 Questions” wallet cards.
- Doctors are willing to have cost conversations but often are waiting for patients to initiate the conversation.
- A majority of physicians consider out-of-pocket costs when making a clinical decision, yet infrequently have cost conversations.
- Many physicians are unlikely to discuss costs unless the patient brings it up.
- Barriers to discussion of costs included time with patients, lack of transparency of costs.
Perez and colleagues recently completed a national survey about costs conversations across health system staff, seeking to identify whom patients seek out most often to discuss costs of care. Perez said the findings will be used to develop workflows that facilitate costs conversations with the most appropriate hospital or health system personnel.
See more studies on cost-of-care conversations in a special supplement of the May 7 issue of Annals of Internal Medicine and learn more about tools created from that research.”
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