Make Cost Part of the Conversation with Patients


With health care costs and patient deductibles rising, physicians are discovering that cost is an integral part of the conversation with patients during an office visit.

Studies have shown that patients and physicians want to engage in such discussions, despite worries about potential awkwardness. Physician advocates and medical societies say these conversations could lead to lower costs for patients without lessening the standard of care.

How a practice brings patients into this conversation is important. Surveys have found that some patients are hesitant to talk about their finances to a physician, and others demand the gold standard of care for themselves, believing anything less expensive is less effective.

Susan Dorr Goold, MD, a professor of internal medicine at the University of Michigan Medical School, helped survey more than 200 insured people in 2011. The study asked participants to imagine themselves with various symptoms and a choice of treatments that vary slightly in effectiveness but significantly in cost. Most patients wanted the most expensive option for themselves, Dr. Dorr Goold said. Some wanted to "get back at" insurance companies for the high costs they pay in insurance.

"One of the things we found is more expensive always means better to many patients when it comes to their own health care, even though that's not always true," Dr. Dorr Goold said.

Steps to starting a dialogue

Physicians need to have their patients' trust, which will help when recommending a specialist the patient has never seen before.

Speak to patients in non-technical language. When refusing to do a certain test or procedure, provide the patient with literature on the subject or read it together. You should discuss what specific treatment is recommended and what is not recommended; this helps to show that you care about the patient and that you are up to date on the latest treatments and techniques.

Physicians should also talk to patients in an authoritative, matter-of-fact way to make them understand that their asking about insurance is a medical question, not a personal question. Physicians should not ask about ability to pay, but rather the extent of their insurance coverage.

Some physicians tell of patients who didn't fill prescriptions or refused treatment due to a lack of money. Studies have found that patients want physicians to help them make the best decision medically and financially. For patients who have trouble paying, physicians can prescribe generic drugs and instruct patients which pharmacies have good offers. Physicians can also recommend freestanding imaging centers, which have lower costs than hospitals.

There are ways for a physician to tackle the subject of cost successfully with patients. They include using the deferral strategy when patients want an unnecessary procedure such as an MRI for back pain that started only a few days ago. You can tell the patient it doesn't make sense to have this procedure at this time but it might make sense later, and instruct them to return in a couple weeks to determine the best course of action.

It is also recommended that doctors stand on their personal integrity, explaining that expensive doesn't always mean better and informing patients that no test is 100% accurate.