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Patients have questions about costs. How should physicians respond?

By Prianca Pai

May 10, 2019

Editor's note: This story was updated on June 5, 2019.

It's official: Health care costs are a hot topic in the press and among patients—no longer a subject reserved solely for economists and policy wonks. It's no surprise, given the stories of patients across the country who've been surprised by exorbitant medical bills, such as the history teacher in Texas with a $108,951.31 medical bill for a heart attack, or the Vermont skier who paid a $18,442 medical bill for a broken leg.

Infographic: What patients want along their financial journey

And these cases aren't uncommon. In fact, a 2018 survey showed that 57% of Americans have been surprised by a medical bill. Beyond one-off surprise medical bills, patients also face increasing day-to-day health care costs. By just one measure, nearly 20% of patients have asked their physicians for lower-cost medications, and 11% of U.S. adults have skipped doses of their medicine to reduce costs.

Patients want to talk about health care costs—but physicians aren't always ready

What does this mean for your physicians? Cost is now the elephant in the exam room—although research shows 70% of Americans want to have cost-of-care conversations with their providers, only 28% report having these conversations. One reason is that physicians don't feel equipped to bring the topic up with patients—or to navigate it when patients bring it up themselves. Another reason is that many health systems have not yet clearly defined physicians' role in cost-of-care conversations.

We're certainly not arguing that physicians should become financial advisors. However, we do think physician leaders need to take a well-articulated stance on physicians' role in cost-of-care conversations with patients, and then prepare physicians to step into that role.

Two ways to prepare physicians to talk about the cost of care

Based on our conversations with physicians across the country, here are two ways physician leaders can prepare physicians to talk about health care costs:

  1. Establish a point of contact for patients with financial questions.

    Providers often do not know where to send patients who have cost-of-care questions. At minimum, organizations should ensure physicians are aware of internal financial services for patients, so physicians can direct patients to the right point of contact in a respectful, sensitive manner.

  2. Equip physicians to proactively start cost conversations.

    Studies show that while most patients want to discuss cost, many are uncomfortable initiating the conversation. In fact, many patients assume that asking about cost could decrease the quality of their care. You can address this issue by training your physicians to take the lead on these conversations. Physicians can proactively offer to refer patients to internal services, such as financial counseling and payment plans. With this approach, there's good news for time-pressed physicians: Research shows that these conversations often only take a minute!

    Equipping physicians to address patient cost questions is a win-win for both quality and experience. Affordable services and medicines help patients adhere to their prescribed care plan. And cost-of-care conversations can build trust between doctors and patients.

    Looking for resources to help get physicians started? Consider using these:


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