Are Your Healthcare Prices Outrageous? Here's What Happens When Prices Come Out Of The Dark



They both had shoulder pain, persistent despite weeks of physical therapy. Both received MRI examinations at reputable radiology facilities, looking for things like rotator cuff tears, labral disruptions and other anatomical abnormalities. What was different was the price they paid for the MRI, with one patient paying $1000 more than the other. Welcome to the crazy American medical marketplace!
Health care prices in the US vary substantially across providers, in part because those prices are so often opaque. When primary care physicians order MRIs for their patients, for example, few patients shop around for affordable radiology centers. There is no reason to shop, because most probably wouldn’t find out what the price was anyway.
That may soon change, if promising results from a recent experiment hold true. The experiment was launched by AIM Specialty Health, an insurance-like company that tries to manage the cost of expensive tests and procedures. The company decided to call patients up on the phone whenever the patients had scheduled MRIs that were either substantially more expensive than competing providers, or were going to be performed by a radiology group rated as significantly lower in quality than its competitors.
After receiving these phone calls, some patients shrugged their aching shoulders and went to whichever facility they felt like going to, realizing they weren’t going to pay out-of-pocket for their MRIs anyway. For example, if a patient had reached her out-of-pocket maximum for the year, then going to a high priced MRI facility would not affect her pocketbook. So she might stick with her originally scheduled test. But other patients, once they learned about the price and quality of alternative providers, canceled their originally scheduled scans and rescheduled with a competitor.
(To read the rest of this article, please visit Forbes.)

6 Tips for Determining if a Doc-in-the-Box Is Right for You

A friend of mine recently had a very sore throat. She knew how to manage her symptoms–lozenges, warm tea and the like. But she was worried she might have strep and would therefore need antibiotics. That should be a simple question to answer with a quick trip to the primary care clinic. Except that her primary care physician was booked, and if she wanted an unscheduled appointment with someone else in the clinic, she was told that she would probably wait a couple of hours.

So she went to a “doc-in-the-box,” which according to the Urban Dictionary is “any doctor at a walk-in clinic.” She paid a modest fee and in a short time received a throat swab. The swab didn’t detect any strep, so she was soon back at home, with a tea kettle brewing and no fear of serious illness.

Primary care clinicians have a new competitor. Minute clinics, retail health clinics and other convenient alternatives are rapidly arising in many parts of the country, meeting unmet demand for timely, affordable care for minor complaints. The biggest players in this field include companies like CVS. These minute-like clinics are a real growth industry.

(To read the rest of this article, please visit Forbes.)

Don't Let Your Physician Tell You What To Do Without Finding Out Your Goals


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A recent study of men with early-stage prostate cancer found no difference in 10-year death rates, regardless of whether their doctors actively monitored the cancers for signs of growth or eradicated the men’s cancers with surgery or radiation.
What does this study mean for patients? Based on research we have conducted on prostate cancer decision-making, the implications are clear: Patients need to find physicians who will interact with them the way a good financial counselor would, taking the time to understand them well enough to help them find the treatment that fits their goals.
Imagine a couple in their 40s who ask a financial counselor for advice on retirement planning, and the counselor tells them how much to invest in domestic and foreign stocks versus bonds versus real estate without asking them about their goals. A good counselor would find out what ages the couple wishes to retire at, what kind of retirement income they hope to live off of, how much risk they are willing to take to achieve their goals, and how devastated they would be if their high return investments go south, forcing them to delay retirement or reduce their retirement spending.
Far too often in medical care, physicians don’t behave like good financial counselors–they give treatment recommendations without taking the time to understand their patients’ goals. Consider early-stage prostate cancer, a typically slow-growing tumor that is not fatal for the vast majority of patients who receive the diagnosis. In some men, the tumor lies indolent for decades.
For that reason, men sometimes choose to monitor their cancers–have their doctors conduct regular blood tests or biopsies to see if the tumor is beginning to spread. Such monitoring has the advantage of being relatively noninvasive, but it can create anxiety for patients who wonder, every six months, whether their next checkup will bring bad news.
For that reason, some men prefer active treatments like surgery or radiation that eradicate their cancers and therefore reduce cancer-related anxiety. But these more active treatments have their own downsides–each treatment is relatively arduous, and they can cause both erectile dysfunction and urinary incontinence.
The choice between active treatment and active monitoring depends on a patient’s goals–on how they view the trade-off between outcomes like cancer-related anxiety and erectile dysfunction. When counseling patients with early-stage prostate cancer, physicians need to help patients focus on these trade-offs.
(To read the rest of this article, please visit Forbes.)
 

Out of Control Physicians: Too Many Doctors Doing Too Many Things to Too Many Patients


My father is 92 years old, and I am beginning to wonder whether the best thing for his health would be to stay away from doctors. That’s because well intentioned physicians often expose their elderly patients to harmful and unnecessary services out of habit. That’s certainly the message I absorbed after reading a recent issue of JAMA Internal Medicine that published three studies documenting the worrisome frequency with which internists like me over-test and over-treat our patients. I am going to briefly describe these three studies before laying out some ideas about what’s going on here.
One study explored the use of PSA screening among men with limited life expectancy. The PSA blood test is used to screen men for prostate cancer. The test is controversial, with some groups saying there is no evidence it benefits anyone and others saying it is a crucial way to reduce prostate cancer deaths. Despite this controversy, almost everyone agrees that when people have limited life expectancy–when, because of age and other illnesses, they probably have fewer than five years to live–the PSA test does more harm than good. But some physicians nevertheless continue to order PSA tests, even in men close to the end of their lives.
The study, which analyzed data from Veteran’s Affairs medical centers, found out that patients receiving care from “attending physicians”–more senior physicians–were more likely to receive harmful PSA tests than patients receiving care from physicians still in training. Indeed, 40% of patients expected to live five or fewer years received PSA tests from experienced physicians, versus only 25% receiving care from trainees :
Out Of Control Too Many Doctors Doing Too Many Things To Too Many Patients Fig 2
The second study looked at carotid artery imaging in people 65 years or older. The carotid arteries are the large vessels on either side of your neck, the ones you can feel your pulse on. They are the main supply of blood to the brain. People who get blockages in their carotid arteries are at risk for strokes.
Carotid imaging with tests like ultrasound can identify narrowing of these important arteries, potentially revealing partial blockages in time to fix them before they fully occlude. In the old days, I’d place my stethoscope on a patient’s neck to listen to the harsh sound of blood squeezing its way through these blockages. Upon hearing a worrisome whoosh, I’d send my patient for imaging and then, if my suspicions were warranted, would refer the patient to a neurovascular surgeon, who would decide whether to perform a procedure to open up the artery.
But now, we physicians are being told to be more cautious. The benefits of all these tests and treatments aren’t so clear in many patients. The risks of the surgery can outweigh the benefits in people with no history of stroke or stroke-like symptoms. Nevertheless, many physicians continue to test and treat aggressively.
To read the rest of this article, please visit Forbes.

What Behavioral Economics Get Wrong About Improving Healthcare


It is notoriously difficult to change physician behavior. When it’s discovered that primary care physicians are, say, prescribing too few cholesterol pills or too many antibiotics, it will not be easy to change those behaviors. Physicians are strong-willed people, with lots of things competing for their attention and with many well ingrained habits.
That’s why I should be excited about several recent studies establishing successful ways of changing physician behavior. One trial, which I wrote about earlier, showed that physicians were less likely to inappropriately prescribe antibiotics after receiving feedback on how their prescribing habits compared to their peers. Another trial, published in the New England Journal of Medicine showed that an intervention combining professional education, informatics and financial incentives reduced how often physicians inappropriately prescribed high-risk medications like pain pills that can cause GI ulcers. Here is a picture of those results, showing a reduction in high-risk prescriptions after the intervention, a reduction that lasted even after the intervention was no longer being implemented:
What Behavioral Economic Interventions Get Wrong About Improving Healthcare 1
And a third study published in JAMA showed that financial incentives informed by insights from behavioral economics increased the likelihood of getting patients’ cholesterol under control.
To read the rest of this article, please visit Forbes.

Doctors Can't Be Trusted to Tell Patients Whether They Should Receive Robotic Surgery

Patients often rely on physicians for information about their treatment alternatives. Unfortunately, that information is not always objective.
Consider a man with early stage prostate cancer interested in surgical removal of his tumor, but uncertain whether it is better for the surgery to be performed with the help of robotic technology. He asks his surgeon for advice, and the surgeon explains that, while robotic surgeries have some advantages (smaller incisions, less blood loss), the advantages are “tiny and unimportant.” And besides: “You do have some smaller incisions with the robotic, but if you added up all the incisions from all the ports and from the incision to remove the prostate itself, it ends up equaling about the same incision length.”
Can that physician’s description of robotic technology be trusted?
My friend and colleague Angie Fagerlin led a study of prostate cancer decision-making that took place across four Veterans Affairs medical centers. As part of that study, she audio-recorded clinical interactions between patients and their surgeons. In some of these interactions, patients asked about the pros and cons of robotic surgery.
As it turns out, some urologists worked at VAs that had access to robotic equipment and others did not. In an analysis lead by Karen Scherr (an MD/PhD student at Duke), our research team discovered that surgeons who had access to the robot were more generous in describing its advantages over standard “open” surgery. When no robot was available, physicians downplayed its advantages. This is illustrated in the following figure, showing the percent of statements physicians made indicating that robotic surgery was inferior, equivalent or superior to traditional surgical approaches:
Doctors Can't Be Trusted Robotic Surgery
Importantly, I do not think physicians are willfully misleading patients about the pros and cons of robotic surgery. Instead, I think most physicians believe the robot is better (in the right hands) but when it is unavailable, doctors try to reassure patients that they will still receive state-of-the-art care. For example, one patient expressed anger that the robot was not available at his VA Hospital: “you see, that’s what’s so stupid about the VA!” The physician tried to assuage his concerns: “If you look at long-term outcomes related to cancer and cancer recurrence,” the surgeon said, “there has really been no difference. That’s why the VA system has not really invested in the robot.”
To read the rest of this article, please visit Forbes.

Peer Comparison Can Reduce Antibiotic Prescribing

Very interesting article in the Lancet recently, from the nudge unit in the United Kingdom. They give physicians feedback on how much they prescribed antibiotics compared to their peers, and found that such feedback reduced antibiotic prescriptions.
Peer Comparison Can Reduce Antibiotic Prescribing
I hope to see more of this work!
 
 

Doctor Knows Best?

Peter Ubel Sport Coat
Photo Credit: NIH

Here is a write-up of a talk I recently gave at the NIH. The topic is a good one, about doctors and decision making and all that crap. But the real importance of linking you to the story is to find out if you hate my sport coat as much as my wife does. It is the only one I own now, and I’ve had it for 25+ years. Time for a new one?

Does doctor always know best? Patients often ask their doctor: “What would you do in my situation?” But as the doctor explains the risks and benefits of treatment options and imparts advice, it’s important to remember there’s a human behind that medical chart, a patient with unique values, opinions and personal preferences.
A doctor’s recommendation often influences a patient’s treatment choice, so the clinician has a huge moral responsibility to recommend well, said Dr. Peter Ubel, a physician and behavioral scientist who teaches public policy and business at Duke University. He led an animated, thought-provoking discussion about shared decision-making among doctors and patients at a bioethics lecture Mar. 22 in Lipsett Amphitheater.
“People want to be heard and understood. That, to me, is what shared decision-making is; that’s what partnership is,” said Ubel, who helps prepare business students for jobs in health care. “What we need to do as clinicians is to get better at eliciting those patient preferences. [Clinicians should tell patients]:‘I’m the expert on medical facts, but you’re the expert on you.’”
Ubel used the example of a patient with low-grade prostate cancer who was trying to decide between surveillance or surgery and radiation. Whether he chose the passive or active approach, the survival rate was the same. But with waiting comes anxiety, and with the medical procedures, he’d run the risk of incontinence and erectile dysfunction.
In this case, how worried was the patient about those side effects? What were his life goals? Asking these kinds of questions can help determine the best course of action. In a similar case, a patient said he preferred the watch-and-wait approach, that he could more easily pursue active treatment after he retired in a couple of years.
“All else equal, the treatment people receive should have something to do with what they care about and these baseline preferences,” said Ubel.
The doctor also should consider the patient’s reaction when delivering the diagnosis, said Ubel. In a urology office, a doctor told a patient he had slow-growing cancer, then tossed out a lot of convoluted, vague information. The doctor may think it’s not an aggressive case so it’s not bad news, but the patient probably only heard, “you’ve got cancer” and tuned out the rest.
People need time to recover from bad news before making an informed decision. Ubel warned that information overload reduces comprehension and retention, and ultimately affects the patient’s choice.
“I think in part because of the way we’re taught in medical school about informed consent and patient autonomy, there’s this big emphasis on information,” said Ubel. “We inform the hell out of patients in jargon they can’t understand at a time when they’re not ready to take on complex information.”
If we have too many choices and too much information to process, Ubel said, people disengage. And patients might just ask for the doctor’s advice without really understanding the diagnosis and treatment alternatives.
“One of the problems with shared decision-making and promoting patient autonomy is that thorough communication is not always good communication,” he said. “Good communication takes time; it takes time to deliver it well and it takes time for the patient to absorb the information.”
In one survey, urologists said they only dispensed advice after gauging which way the patient was leaning. The urologists usually asked whether the patient had normal sexual function, but only 12 percent asked whether sexual function was important to the patient. And, astoundingly, only 13 percent said this preference should factor into deciding the right treatment. Look beyond age and test results, said Ubel; consider what patients care about.

To read the rest of this story, please visit the NIH.
 

Here's How a Great Doctor Helps Her Patient Make a Cost-Conscious Treatment Decision


Photo Credit: Consumer Reports
Photo Credit: Consumer Reports

Sometimes in my research on physician/patient communication, I come across a doctor who is so good with her patients, I have to share their bedside manner with you. The most recent example is a (to remain unnamed) oncologist in the Northeastern United States who practically gave a primer on shared decision making when caring for a patient with metastatic cancer.
The patient (I’ll call her Jennifer Decker) had stage 4 breast cancer, which had metastasized to liver and bone, the latter leaving her with substantial pain. Worse yet, a PET scan she received a week before her clinical appointment showed that the cancer had progressed significantly since her last test. “So we need to think about what to do next,” her oncologist explained.
A great statement, the idea of “we” – both doctor and patient – making a medical decision together. That’s a paradigm known as shared decision making, and is one that in my research I find is rarely achieved. Many doctors say they want to partner with patients in making healthcare choices, but most do not know how to accomplish this goal. Instead, they often earnestly overwhelm patients with well-intentioned information, at which point patients ask “what should I do?,” and the doctors point them towards treatments, even though they have done little to discuss what patients think about the pros and cons of their alternatives.
This oncologist, on the other hand, partnered like a pro. He explained that the first big choice Decker had to make was whether or not to have chemotherapy, to try to slow the spread of the cancer: “The biggest decision we’ve got to make right now is chemotherapy or not. Now chemo, thankfully, comes in a huge variety. There are probably a dozen drugs that work for breast cancer like yours. And you can use them one at a time. You don’t have to use two, three, or four.”
He explained some of the main differences between available treatments, the main one being that some treatments were given intravenously, meaning she would have to come into the clinic for treatment. But one treatment, Xeloda, could be taken as a pill, “and it’s not less chemo than any other product,” he assured her. He added, “if it doesn’t work, we have tons of other options you can switch to, but they are intravenous, so you have to come here and get an infusion.”
Decker asked a few questions and then told him she wanted to try one of the treatments: “I got to do what I need to do.”
The visit was already a p rimer on shared decision making, with the oncologist clearly and patiently explaining the patient’s treatment choices, simplifying the decision to its first branch point – chemo or not chemo – rather than overwhelming her with in-depth information on all her treatment options. Then, when he moved to the next branch of the decision tree, things got even more spectacular.
(To read the rest of the article, please visit Forbes.)

More Coverage of Our Research on Out-Of-Pocket Cost Conversations

Take one Per Day as Affordable.Here is a nice summary of our research, published by an excellent reporter at The American Journal of Managed Care:

A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the way of helping patients navigate out-of-pocket spending. The study, published in Health Affairs and led by Peter A. Ubel, MD, with fellow researchers, found that for optimum utilization of consumer healthcare markets, physicians need to be prepared to help patients navigate out-of-pocket expenses during clinical encounters.Most of the failures resulted from systemic barriers to healthcare spending conversations, such as a lack of price transparency. Some behaviors reflected a failure to fully engage with patients’ financial concerns—from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending.Study Method and Results
For the study, the researchers analyzed patient-physician interactions for breast cancer, depression, and rheumatoid arthritis. Only these 3 medical conditions were chosen for the study because they often involve expensive healthcare interventions that could lead to high out-of-pocket expenses.
Excluded were visits conducted by primary care physicians, nurse practitioners, and nurses; visits conducted outside of United States; and visits involving patients younger than 18 years. The final sample consisted of 1755 visits: 677 breast oncology, 656 rheumatoid arthritis and 422 psychiatry. All visits occurred between May 2010 and February 2014.
The physician behaviors that led to missed opportunities to reduce out-of- pocket expenses were divided into 2 broad categories:

  • The physician’s failure to address the patient’s financial concerns, meaning they didn’t make an explicit effort to acknowledge the seriousness of the patient’s concerns
  • Instances where physicians did make explicit efforts to deal with patients’ financial concerns but failed to resolve them satisfactorily

Sometimes, patients explicitly mentioned their financial troubles, but physicians failed to give it complete attention because of clinical distractions. Many physicians get too involved in entering data into electronic medical records or examining patients that they tend to overlook unexpected and observational issues such as patient financial concerns. In other cases, when physicians do understand the patients’ money problems, they dismiss the possibility of solving it for the patients. – See more at: http://www.ajmc.com/newsroom/poor-physician-patient-communication-leads-to-higher-out-of-pocket-spending#sthash.TjgriRFV.dpuf

A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the way of helping patients navigate out-of-pocket spending. The study, published in Health Affairs and led by Peter A. Ubel, MD, with fellow researchers, found that for optimum utilization of consumer healthcare markets, physicians need to be prepared to help patients navigate out-of-pocket expenses during clinical encounters.Most of the failures resulted from systemic barriers to healthcare spending conversations, such as a lack of price transparency. Some behaviors reflected a failure to fully engage with patients’ financial concerns—from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending.Study Method and Results
For the study, the researchers analyzed patient-physician interactions for breast cancer, depression, and rheumatoid arthritis. Only these 3 medical conditions were chosen for the study because they often involve expensive healthcare interventions that could lead to high out-of-pocket expenses.
Excluded were visits conducted by primary care physicians, nurse practitioners, and nurses; visits conducted outside of United States; and visits involving patients younger than 18 years. The final sample consisted of 1755 visits: 677 breast oncology, 656 rheumatoid arthritis and 422 psychiatry. All visits occurred between May 2010 and February 2014.
The physician behaviors that led to missed opportunities to reduce out-of- pocket expenses were divided into 2 broad categories:

  • The physician’s failure to address the patient’s financial concerns, meaning they didn’t make an explicit effort to acknowledge the seriousness of the patient’s concerns
  • Instances where physicians did make explicit efforts to deal with patients’ financial concerns but failed to resolve them satisfactorily

Sometimes, patients explicitly mentioned their financial troubles, but physicians failed to give it complete attention because of clinical distractions. Many physicians get too involved in entering data into electronic medical records or examining patients that they tend to overlook unexpected and observational issues such as patient financial concerns. In other cases, when physicians do understand the patients’ money problems, they dismiss the possibility of solving it for the patients. – See more at: http://www.ajmc.com/newsroom/poor-physician-patient-communication-leads-to-higher-out-of-pocket-spending#sthash.TjgriRFV.dpuf

A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the way of helping patients navigate out-of-pocket spending. The study, published in Health Affairs and led by Peter A. Ubel, MD, with fellow researchers, found that for optimum utilization of consumer healthcare markets, physicians need to be prepared to help patients navigate out-of-pocket expenses during clinical encounters.Most of the failures resulted from systemic barriers to healthcare spending conversations, such as a lack of price transparency. Some behaviors reflected a failure to fully engage with patients’ financial concerns—from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending.Study Method and Results
For the study, the researchers analyzed patient-physician interactions for breast cancer, depression, and rheumatoid arthritis. Only these 3 medical conditions were chosen for the study because they often involve expensive healthcare interventions that could lead to high out-of-pocket expenses.Excluded were visits conducted by primary care physicians, nurse practitioners, and nurses; visits conducted outside of United States; and visits involving patients younger than 18 years. The final sample consisted of 1755 visits: 677 breast oncology, 656 rheumatoid arthritis and 422 psychiatry. All visits occurred between May 2010 and February 2014.
The physician behaviors that led to missed opportunities to reduce out-of- pocket expenses were divided into 2 broad categories:

  • The physician’s failure to address the patient’s financial concerns, meaning they didn’t make an explicit effort to acknowledge the seriousness of the patient’s concerns
  • Instances where physicians did make explicit efforts to deal with patients’ financial concerns but failed to resolve them satisfactorily

Sometimes, patients explicitly mentioned their financial troubles, but physicians failed to give it complete attention because of clinical distractions. – See more at: http://www.ajmc.com/newsroom/poor-physician-patient-communication-leads-to-higher-out-of-pocket-spending#sthash.TjgriRFV.dpuf

A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the way of helping patients navigate out-of-pocket spending. The study, published in Health Affairs and led by Peter A. Ubel, MD, with fellow researchers, found that for optimum utilization of consumer healthcare markets, physicians need to be prepared to help patients navigate out-of-pocket expenses during clinical encounters.Most of the failures resulted from systemic barriers to healthcare spending conversations, such as a lack of price transparency. Some behaviors reflected a failure to fully engage with patients’ financial concerns—from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending.Study Method and Results
For the study, the researchers analyzed patient-physician interactions for breast cancer, depression, and rheumatoid arthritis. Only these 3 medical conditions were chosen for the study because they often involve expensive healthcare interventions that could lead to high out-of-pocket expenses.Excluded were visits conducted by primary care physicians, nurse practitioners, and nurses; visits conducted outside of United States; and visits involving patients younger than 18 years. The final sample consisted of 1755 visits: 677 breast oncology, 656 rheumatoid arthritis and 422 psychiatry. All visits occurred between May 2010 and February 2014.
The physician behaviors that led to missed opportunities to reduce out-of- pocket expenses were divided into 2 broad categories:

  • The physician’s failure to address the patient’s financial concerns, meaning they didn’t make an explicit effort to acknowledge the seriousness of the patient’s concerns
  • Instances where physicians did make explicit efforts to deal with patients’ financial concerns but failed to resolve them satisfactorily

Sometimes, patients explicitly mentioned their financial troubles, but physicians failed to give it complete attention because of clinical distractions. – See more at: http://www.ajmc.com/newsroom/poor-physician-patient-communication-leads-to-higher-out-of-pocket-spending#sthash.TjgriRFV.dpuf

A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the way of helping patients navigate out-of-pocket spending. The study, published in Health Affairs and led by Peter A. Ubel, MD, with fellow researchers, found that for optimum utilization of consumer healthcare markets, physicians need to be prepared to help patients navigate out-of-pocket expenses during clinical encounters.Most of the failures resulted from systemic barriers to healthcare spending conversations, such as a lack of price transparency. Some behaviors reflected a failure to fully engage with patients’ financial concerns—from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending.Study Method and Results
For the study, the researchers analyzed patient-physician interactions for breast cancer, depression, and rheumatoid arthritis. Only these 3 medical conditions were chosen for the study because they often involve expensive healthcare interventions that could lead to high out-of-pocket expenses.Excluded were visits conducted by primary care physicians, nurse practitioners, and nurses; visits conducted outside of United States; and visits involving patients younger than 18 years. The final sample consisted of 1755 visits: 677 breast oncology, 656 rheumatoid arthritis and 422 psychiatry. All visits occurred between May 2010 and February 2014.
The physician behaviors that led to missed opportunities to reduce out-of- pocket expenses were divided into 2 broad categories:

  • The physician’s failure to address the patient’s financial concerns, meaning they didn’t make an explicit effort to acknowledge the seriousness of the patient’s concerns
  • Instances where physicians did make explicit efforts to deal with patients’ financial concerns but failed to resolve them satisfactorily

Sometimes, patients explicitly mentioned their financial troubles, but physicians failed to give it complete attention because of clinical distractions. – See more at: http://www.ajmc.com/newsroom/poor-physician-patient-communication-leads-to-higher-out-of-pocket-spending#sthash.TjgriRFV.dpuf

A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the way of helping patients navigate out-of-pocket spending. The study, published in Health Affairs and led by Peter A. Ubel, MD, with fellow researchers, found that for optimum utilization of consumer healthcare markets, physicians need to be prepared to help patients navigate out-of-pocket expenses during clinical encounters.Most of the failures resulted from systemic barriers to healthcare spending conversations, such as a lack of price transparency. Some behaviors reflected a failure to fully engage with patients’ financial concerns—from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending.Study Method and Results
For the study, the researchers analyzed patient-physician interactions for breast cancer, depression, and rheumatoid arthritis. Only these 3 medical conditions were chosen for the study because they often involve expensive healthcare interventions that could lead to high out-of-pocket expenses.Excluded were visits conducted by primary care physicians, nurse practitioners, and nurses; visits conducted outside of United States; and visits involving patients younger than 18 years. The final sample consisted of 1755 visits: 677 breast oncology, 656 rheumatoid arthritis and 422 psychiatry. All visits occurred between May 2010 and February 2014.
The physician behaviors that led to missed opportunities to reduce out-of- pocket expenses were divided into 2 broad categories:

  • The physician’s failure to address the patient’s financial concerns, meaning they didn’t make an explicit effort to acknowledge the seriousness of the patient’s concerns
  • Instances where physicians did make explicit efforts to deal with patients’ financial concerns but failed to resolve them satisfactorily

Sometimes, patients explicitly mentioned their financial troubles, but physicians failed to give it complete attention because of clinical distractions. – See more at: http://www.ajmc.com/newsroom/poor-physician-patient-communication-leads-to-higher-out-of-pocket-spending#sthash.TjgriRFV.dpuf

A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the way of helping patients navigate out-of-pocket spending. The study, published in Health Affairs and led by Peter A. Ubel, MD, with fellow researchers, found that for optimum utilization of consumer healthcare markets, physicians need to be prepared to help patients navigate out-of-pocket expenses during clinical encounters.
Most of the failures resulted from systemic barriers to healthcare spending conversations, such as a lack of price transparency. Some behaviors reflected a failure to fully engage with patients’ financial concerns—from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending.
Study Method and Results
For the study, the researchers analyzed patient-physician interactions for breast cancer, depression, and rheumatoid arthritis. Only these 3 medical conditions were chosen for the study because they often involve expensive healthcare interventions that could lead to high out-of-pocket expenses.
Excluded were visits conducted by primary care physicians, nurse practitioners, and nurses; visits conducted outside of United States; and visits involving patients younger than 18 years. The final sample consisted of 1755 visits: 677 breast oncology, 656 rheumatoid arthritis and 422 psychiatry. All visits occurred between May 2010 and February 2014.
The physician behaviors that led to missed opportunities to reduce out-of- pocket expenses were divided into 2 broad categories:

  •     The physician’s failure to address the patient’s financial concerns, meaning they didn’t make an explicit effort to acknowledge the seriousness of the patient’s concerns
  •     Instances where physicians did make explicit efforts to deal with patients’ financial concerns but failed to resolve them satisfactorily

Sometimes, patients explicitly mentioned their financial troubles, but physicians failed to give it complete attention because of clinical distractions. Many physicians get too involved in entering data into electronic medical records or examining patients that they tend to overlook unexpected and observational issues such as patient financial concerns. In other cases, when physicians do understand the patients’ money problems, they dismiss the possibility of solving it for the patients.

To read the rest of this story, please visit The American Journal of Managed Care.

PeterUbel