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Analysis

Doctors Say They Lack Training to Discuss Healthcare Costs

By Steven Porter  
   July 11, 2018

Healthcare leaders overwhelmingly believe physicians aren't trained to have informed conversations about how much the care they provide will cost their patients. That could impede value-based care.

An overwhelming majority of healthcare leaders who responded to a recent survey said they believe physicians are ill-equipped to discuss healthcare costs effectively.

About 86% of the 571 clinicians, clinical leaders, and executives who responded said physicians lack the training they would need to discuss the cost considerations affecting their patients, according to data released Tuesday by University of Utah Health in partnership with NEJM Catalyst.

Another 8% said they neither agreed nor disagreed with the prompt.

Robert Glasgow, MD, chief value officer for University of Utah Health's surgery department in Salt Lake City, said it's easy for physicians to feel powerless to influence prices set by insurers or drug-makers. But that doesn't mean doctors should resign themselves to shrug whenever asked about the price tags attached to each treatment.

"We need to train physicians to give patients enough cost data," Glasgow said in the survey report. "That’s the starting block of high-value care."

That being said, doctors shouldn't be pressured to come up with "an itemized bill," nor should they let their interactions with patients be reduced to mere business transactions, he added.

This idea that providers should be enabling consumers to make price-conscious healthcare decisions is, of course, not new. Ohio lawmakers even passed a requirement for providers to give patients a "good faith" estimate of how much non-emergency services would cost. A judge barred the state from implementing the law, however, amid a challenge by the Ohio Hospital Association and others, as The Columbus Dispatch reported.

Even without price-transparency laws, though, the rapid growth of consumerism in healthcare means patients are increasingly expecting price information from their providers, as Gregory Freeman wrote for HealthLeaders Media.

"Doctors and hospitals are going to be getting more and more questions around cost and quality, and in the early stages of consumer-driven healthcare they often looked at the patient and said they no idea what this service would cost or how to measure quality," said Alegeus senior vice president of consumerism and strategy John Young at the time.

"That is becoming less common today as doctors and hospitals develop better mechanisms for answering those questions, which in some cases means having a specific department or person to refer the patient to," Young added.

What's Driving Costs? Docs Blame Pharma

About 72% of the 571 people who responded to the survey sponsored by University of Utah Health. When asked which stakeholders are to blame for high healthcare costs, the respondents pointed their fingers most vigorously at the pharmaceutical industry—but insurers and providers were not that far behind.

A majority of respondents listed the following stakeholder categories as having a "strong impact" on the cost of healthcare:

  • Pharmaceutical/biotech companies: 87%
  • Health plans/HMOs/insurers: 81%
  • Hospitals/health systems/physician organizations: 75%
  • Medical device manufacturers: 67%
  • Government/regulators: 60%

Several other stakeholder categories ranked lower in the list of factors having a "strong impact" on healthcare costs: individual clinicians (28%), employers (26%), and patients (23%).

The full survey report is available for download from the NEJM Catalyst website.

Steven Porter is editor at HealthLeaders.


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