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Why putting prices in EHRs will help doctors keep costs in check

Navigating today’s health care system can be like wheeling a shopping cart through a store and not knowing how much the items you’ve selected cost until you get to the cash register. But one way to improve transparency while simultaneously strengthening the patient-physician relationship would be to include prescription-drug prices in electronic health records, according to a recent JAMA Viewpoints column.

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“In an era of rising costs, the role of the physician in promoting cost-consciousness must increase,” states the essay, co-written by Brian J. Miller, MD, MPH, with MedStar Georgetown University Hospital; Jennifer M. Slota, with Northwestern University Feinberg School of Medicine’s Center for Healthcare Studies; and AMA Board of Trustee Chair Jesse M. Ehrenfeld, MD, MPH, with the Vanderbilt University School of Medicine.

“Prices may be either relative or absolute,” the authors added. “Ideally, prices should be meaningful and actionable.”

The column cites 30 years of research showing that fewer expensive diagnostic tests are ordered when physicians know the costs associated with them.

“Cost-consciousness represents the next evolution of 21st-century medical practice, promoting physicians and patients together as leaders of positive change,” the authors wrote, adding that “displaying price information in EHRs could mark the next step in the transformation of the practice of medicine.”

The authors suggested that the inclusion of prices, either “absolute or relative,” could be a vendor requirement for EHR-product certification leading to a new generation of EHRs that include prices for drugs, tests, surgical procedures and physician visits.

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Prompting the price conversation

The authors also acknowledged a potential downside of adding drug-price data to the EHR.

“Physicians may find the inclusion of yet more information in the EHR frustrating, so there could be unintended consequences of adding cost information,” they wrote. “Regardless, stimulating dialogue by providing physicians and patients with pricing information at the point of service makes intuitive sense.”

Rewards would include facilitating physicians’ role as stewards of health care resources and strengthening the bond they have with their patients.

“Navigating an administratively complex care delivery system in the setting of severe and chronic illness is overwhelming,” the essay states. “Expanding the role of the physician as a guide for and steward of the patient’s health care financial resources is a natural deepening of the patient-physician relationship.”

At a recent AMA Annual Meeting, the delegates adopted policy stating the AMA will collaborate with other stakeholders to:

  • Explore the current availability and accessibility of EHR, pharmacy and payer functionalities that enable integration of price, insurance coverage, formulary tier and drug utilization-management policies, and patient-cost information at the point of care.
  • Explore what barriers exist to this functionality or access.
  • Explore what is currently being done to address these barriers.
  • Develop and implement a strategic plan for improving the availability and accessibility of real-time prescription cost information at the point of care.

The policy stemmed from an AMA Board of Trustees report that noted that having price information at the point of prescribing could be a deciding factor in which treatment options are pursued.

“The AMA recognizes that physicians can enhance patient-centered care by balancing costs and the potential for patient adherence to prescriptions in their decision-making related to maximizing health outcomes and quality of care for patients,” the report states. “Improving drug price transparency would increase patient and physician awareness of the overall costs associated with different prescription drug treatment options and ultimately facilitate better-informed, shared treatment decisions that could help reduce prescription drug spending.”

The report also mentions TruthInRx, the AMA grassroots campaign that has been collecting patients’ stories about the negative impact of high prescription-drug prices.