The Senate moved forward last week with The Lower Health Care Costs Act, a sweeping, bipartisan bill that seeks to address surprise medical billing, increase cost transparency, and lower drug prices. For millions of people in this country, such reform is sorely needed: Over a quarter of Americans have trouble paying their medical bills — and it’s preventing patients from getting the care they need.
Affordability is hardly a new problem, of course, but out-of-pocket costs have skyrocketed in the past decade. In 2006, only 4 percent of people with private insurance were enrolled in high-deductible health plans. By 2018, that number had risen to 29 percent. And out-of-pockets costs pose trouble for publicly insured people, too. Medicare beneficiaries with cancer and no supplemental insurance, for example, face average out-of-pocket costs of $8,115 per year. Such high out-of-pocket expenses are tied to delayed or forgone care, lower adherence, and higher mortality.
Senators are hoping to put The Lower Health Care Costs Act up for a vote before their recess next month. But in the meantime, research from the Annals of Internal Medicine reveals a number of ways clinicians can help patients navigate the process of paying for their often costly care.
Ask your patient.
Many physicians report initiating cost-of-care conversations only when they sense patients are struggling financially, relying instead on “clues” like poorly controlled symptoms or care delays. That’s a problem, since patients with affordability concerns are often reluctant to bring them up. Consider it part of your job to screen for financial hardship.
Discuss cost prognosis.
Practitioners are charged with providing patients with as much information as possible about their treatment, and that should include cost. In fact, multiple studies show that patients want regular cost-of-care conversations. And while physicians sometimes worry that talking about financials might deter patients from seeking or pursuing care, the opposite is often true: Cost-of-care conversations enable patients to better plan for expensive treatments, which can increase their adherence.
Physicians often dismiss cost-of-care conversations because of the difficulty of predicting the costs of procedures, diagnostic tests, and drugs. But, according to one study, many patients are mainly concerned with the indirect costs of appointments, such as transportation, child care, and lost income. Many of these costs can often be anticipated and planned for, as long as doctors are willing to have frank conversations with their patients.
Make cost-of-care conversations systematic and routine.
Incorporating a cost-of-care conversation screening system into staff workflow can help determine the existence of financial hardship, alleviate the shame that many patients feel about their financial difficulties, and clarify whom patients feel most comfortable speaking to. In one study where such a system was implemented, not only did providers become more comfortable having cost-of-care conversations, but patients also became less concerned about the costs themselves.
Find a system that works for you.
There’s more than one right way to integrate cost-of-care conversation into your practice. In one study, for example, clinic staff suggested three effective methods for doing so: Charging a single staff member with solving out-of-pocket cost problems so they can develop expertise and efficiency; using the electronic health record (EHR) to document patients’ financial needs; and using the EHR to collect available data on costs and insurance coverage. Trial and error can help determine what strategies work best for you and your team.
Get your staff involved.
As important as developing a system for cost-of-care conversations is, practitioners don’t always have to take the lead. Other staff — medical assistants, financial counselors, and administrators — can be equally effective. In fact, studies show that many patients are just as happy to speak with ancillary staff about costs.
Practice makes perfect.
Studies show that clinicians get better at cost-of-care conversations the more they have them. What’s more, they also take costs into account more often when making medical decisions, and those who use online tools, such as CompareMaine.org, develop an expertise with them.
The 7 Habits of Highly Effective Cost-of-Care Conversations, Annals of Internal Medicine.
Last updated on 10/8/19.