Why are cost-of-care conversations important?

As a physician, I order a test or prescribe treatment based on what I think is best for the patient’s health. Other than medications, I often have no idea what their care will cost. Still, if the patient can’t afford treatment or they receive treatment, but it causes significant financial hardship, I have not done my job. As medical doctors, we take an oath to “do no harm” unto patients. Yet, I have no tools to help me guide patients on what their best options are. This is why cost-of-care discussions are so important. 

Today’s blog will explore how physicians can navigate these cost-of-care discussions and how other teams within your healthcare organization can help. Effective collaboration will ensure your patients receive the right clinical treatment that’s also financially accessible.

Common Barriers to Cost-of-Care Discussions

First, let’s address some common barriers that may prevent physicians and patients from discussing care costs. 

Lack of Time

Oftentimes, physicians believe cost-of-care discussions will be time-consuming and limit the amount of time they could spend discussing the patient’s health condition. However, one study from the Journal of Oncology Practice revealed that cost conversations took a median of 33 seconds in a 12-minute appointment. These conversations take less than a minute and can even save time in the future. This is because discussing costs earlier can prevent issues that are more difficult to address down the road. 

For example, a physician can avoid spending time on the phone with the patient’s pharmacy for an alternative prescription. By talking through costs during the visit, the physician can give their patient an option for a lower-cost medication. Cost-of-care discussions can also eliminate the need to address medication adherence issues in future visits. For a physician to determine whether their patient’s condition worsened because they couldn’t afford to take their prescribed medication could be more time-consuming in the long run. 

Quality of Care

Some patients may be hesitant to share their concerns about costs because they don’t want to negatively impact the quality of care they receive. By sharing their financial constraints, patients worry that they won’t be offered all available care options. This is why physicians should reassure patients that they will make every clinical decision as a team. Patients should trust that they will be presented with all of their treatment options, regardless of cost. 

How Physicians Can Navigate Cost-of-Care Discussions

To help prompt discussions about costs, the American College of Physicians (ACP) has worked to standardize cost-of-care conversations. After all, cost concerns can be a sensitive topic, but guiding physicians through these tough conversations can help remove financial barriers to care for patients. 

To standardize these discussions, the ACP has created a framework that walks physicians through a patient encounter with specific guidelines that include addressing cost-of-care issues. One step involves screening for financial barriers that limit a patient’s access to care with questions such as:

  • Are you worried about how to pay for your care?
  • If so, how can we help you with these problems?

Then, depending on a patient’s answers, physicians may consider the following (if possible): 

  • Switching to lower-cost alternative treatment or test;
  • Trying generic medications instead of brand name;
  • Adjusting medication dosage or frequency; and/or
  • Postponing non-urgent or elective interventions for a time when the patient has more money available or their deductible has been met. 

Cost-of-Care Discussions are a Team Effort

However, addressing a patient’s cost-of-care concerns cannot, and should not, be on the physician alone. It takes collaboration across teams within the patient’s healthcare system. If a patient needs a specific type of test or treatment, it’s because their physician deems that their condition warrants it. As a physician, my medical advice is not going to change. However, that advice is useless if the patient doesn’t seek recommended care because of concerns about the cost.

It’s important to advocate for the patient. Remind them that they have the right to know price information upfront before they get a test or a treatment. Make sure the patient feels empowered to shop around and request prices when they interact with a hospital’s business office or patient access team.

HFMA advises that patient access teams provide a price estimate and allow patients to make a payment at least 5 days before the scheduled visit. Also, consider letting patients sign up for a payment plan from their estimate.

By showing them payment options that work for their budget earlier, patients are less likely to avoid or skip treatment over cost concerns. If making a payment is not feasible, the patient access team can flag the patient’s account for financial counseling. This can all be accomplished before the patient’s visit – it just starts with a cost-of-care discussion. 

Conclusion

As I’ve said before, healthcare is not solely about price. It is about value, which means both quality and cost of care must be considered. When physicians keep this in mind, they effectively balance the welfare of the patient with the welfare of the health system in which they practice. 

Patientco believes a similar concept can also be adopted by hospital revenue cycle teams. When revenue cycle team members empathize with patients’ financial concerns, health systems see improved financial outcomes. 

We must remember that every patient has different needs, both clinically and financially. No matter what role you play in your healthcare organization, it’s important to advocate for those needs.