This article is more than 5 years old. Information may no longer be current.

Physician behaviors hinder patients in navigating out-of-pocket costs

Recent qualitative findings published in Health Affairs showed that physicians struggled to help patients factor out-of-pocket expenses into their medical decisions.

“Health care consumers cannot expect to make savvy financial decisions if their doctors do not engage with them in productive conversations about the pros and cons of their health care alternatives, including the financial costs,” Peter A. Ubel, MD, professor in the Sanford School of Public Policy at Duke University, told Healio Internal Medicine. “Some physicians say they are reluctant to do so because money talk would contaminate the doctor-patient relationship.”

In 2014, one in three Americans was reported to have difficulty paying health care bills, the researchers wrote. In a previous study, Ubel and colleagues found that patients and physicians discussed strategies to reduce health care expenses about 44% of the time when these topics arose. They also determined, however, that these discussions did not always allow patients to navigate out-of-pocket expenses.

“Many more physicians, I expect, would like to hold such conversations, but struggle to do so because there is no easy way to figure out how much patients will be required to pay out-of-pocket for their medical care,” Ubel said.

In the current study he and his colleagues performed a qualitative study by analyzing physician-patient interactions taken from the Verilogue Point-of-Practice database. They used 677 interactions in breast oncology, 656 in rheumatoid arthritis and 422 in psychiatry that occurred from May 2010 to February 2014 at private practices nationwide.

The researchers found that two broad categories of behaviors led to missed opportunities that could trim out-of-pocket expenses. The first was the physician not acknowledging the seriousness of the patient’s concerns. The second was the physician failing to fully resolve a patient’s financial concerns.

For the first behavior, the researchers cited examples of how physicians missed opportunities to address patient concerns. They included:

• failure to recognize potential financial concern;
• distraction from patients’ financial concern by frustration with the system;
• dismissal of patients’ financial concern; and
• hasty acceptance of patients’ dismissal of financial concerns.

For the second behavior, Ubel and colleagues listed examples of how physicians attempted to address methods to reduce patient costs, but failed to ensure the strategies would work. They included:

• assumption that “coverage” meant full coverage;
• assumption that generic medications are affordable;
• assumption that copayment assistance programs and coupons resolve financial concern;
• temporizing financial burden without discussing any long-term solutions; and
• failure to consider less expensive alternatives.

“Instead of taking patients’ initial descriptors at face value, physicians are trained to ask follow-up questions that illuminate patients’ symptoms,” Ubel and colleagues wrote. “In the same manner, if physicians want to help patients make financially informed medical decisions, they need to learn how to recognize when patients have concerns about the cost of their care.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.