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Money talks: Discussing costs of treatment

Paying for care can be a sensitive doctor-patient discussion. Here is some advice for dealing with those uncomfortable situations.

By Jonathan G. Bethely, amednews staff. Oct. 16, 2006.

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When internist G. Caleb Alexander, MD, an assistant professor at the University of Chicago, was finishing his residency in a Pennsylvania hospital, he found it surprising how infrequently physicians had meaningful discussions with patients about the cost of the clinical decisions being made on their behalf.

Dr. Alexander said he shrugged off the initial observation because most patients in the inpatient setting were too sick to contemplate the cost of their medical treatment. But he began to wonder what happens in the outpatient setting as patients and physicians discuss a treatment course.

"Patient communication [about money] is important, yet it's often neglected," Dr. Alexander said. "It's not so surprising in the inpatient setting because patients are so sick, and there's less willingness to tolerate cost-quality tradeoffs because the stakes are higher."

But the stakes, financially speaking, are going up in the outpatient setting as well. As more patients enter their doctors' offices carrying high-deductible health plans, often with attached health savings accounts, there is a growing shift in the mind-set. As they are assuming more out-of-pocket expenses on their own, patients are asking more from their physicians about the cost of their own health care, and whether a lower-cost procedure might be a better idea. That can be jarring for a physician duty-bound to provide the best course of care, with cost often a secondary concern.

"This issue is a critically important one and there is a woeful lack of attention being given to it," said Nileen Verbeten, vice president of the California Medical Assn. Center for Economic Services. "The profession as a whole is not trained to think about that."