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Don't Fear the Clinician-Patient Cost Conversation

Analysis  |  By Alexandra Wilson Pecci  
   June 10, 2019

Many revenue cycle leaders want to be the gatekeepers of cost information, but clinicians need to have those conversations, too.

Clinicians should be able to discuss healthcare costs with patients and need tools for doing so.

That's the key takeaway from a research partnership between the Robert Wood Johnson Foundation, Avalere Health, the American College of Physicians, America's Essential Hospitals, the National Patient Advocate Foundation, and eight research grantees.

"How do we think about normalizing or routinizing the cost-of-care conversations in the clinical setting?" says Josh Seidman, Avalere senior vice president.

Avalere and the American College of Physicians recently co-authored a commentary in the Annals of Internal Medicine outlining the common barriers to cost-of-care conversations between patients and providers. It also directs clinicians to specific tools and resources for doing so.

Stay in your lane?

For revenue cycle leaders, the thought of physicians discussing treatment costs with patients might send a shiver down their spine. Many participants at the recent HealthLeaders >Revenue Cycle Exchange in Ojai, California, were deeply uneasy about the idea of clinicians attempting to deliver cost information to patients.

Given the volatility around surprise bills and the extremely sensitive, detailed work involved in delivering insurance-specific out-of-pocket cost estimates to patients, it's easy to see why revenue cycle leaders would want to be the gatekeepers of this information.

There seems to be a sense that clinicians might mess things up, especially since price estimate accuracy is so important. Stay in your lane, many revenue cycle leaders say. Let clinicians handle clinical matters and leave the financial stuff to us.

Not my job

Of course, many clinicians would heartily agree with them.

"A lot of clinicians, when you start talking to them about this, they say, 'That's not my job. I didn't go to medical school to talk about costs," Seidman tells HealthLeaders.

Moreover, many clinicians plead ignorant on costs, and want treatment decisions to be based on clinical factors only, not money.

But that's a false dichotomy. Patients make treatment decisions based on cost all the time, and they're doing so with or without talking to their doctor about it.

"If providers aren't having the conversation that doesn't mean it's not happening," Seidman says. He points to research findings like one from the Commonwealth Fund showing that 35% of American adults younger than 64 years old blamed out-of-pocket costs for not getting medical care they needed.

"The reality is patients are going to make those decisions in the absence of that conversation," Seidman says; cost is already dictating the treatment decisions for a significant portion of the population. Since many patients are embarrassed to ask about costs, clinicians should take the lead

End the secrecy around cost-based health choices

When cost is a factor in treatment decisions, clinicians need to be aware of it. Patients may choose to forgo or change their recommended care plan because of costs, and without good information or guidance, patients won't make the best decisions for themselves.

"It really affects not only the care experience," Seidman says. "It also really affects, in some cases, the clinical outcomes for patients."

That's not to say that clinicians will be running patients' insurance information through the hospital's price estimator tool during a clinical encounter.

However, they should be able to initiate cost conversations with patients (who are already thinking about it) and document the patients' financial needs in the medical record.

They should also be equipped to introduce patients to financial assistant resources and other non-clinical staffers, such as financial counselors or advocates or someone in the patient access department, who can help patients navigate the specifics.

Don't go it alone

Using a team-based approach for cost-of-care conversations is one of the recommendations in a set of seven practice briefs, located on the Essential Hospitals Institute website and developed by Avalere and the Robert Wood Johnson Foundation research grantees. The Institute's website also has a set of provider tools for having those conversation.

"Patients appreciate whatever the provider can do," Seidman says. "To know that they respect patients enough to help answer the question, or at least help guide the patients to where the answer will be, is important for how providers can build relationships with patients."

Alexandra Wilson Pecci is an editor for HealthLeaders.


Physicians should initiate cost-of-care conversations with patients.

Unguided healthcare decisions based on cost can negatively affect clinical outcomes.

Use a team-based approach that involves the revenue cycle in cost-of-care conversations between clinicians and patients.

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