It's Time to Talk About the Cost of Healthcare with Your Patients

Ask someone what keeps them awake at night, and there's a good chance they'll tell you they're worried about paying their medical bills. 

A 2016 Gallup Poll found that cost is the most urgent healthcare concern among Americans. And their concerns are well-founded, as a  growing number of people are having trouble paying their medical bills. In fact, about one out of every four people experience difficulty paying for their healthcare. Unfortunately, when people struggle with those bills, they often put off care—even much-needed care.  

Meanwhile, healthcare costs in the United States continue to skyrocket. Experts are saying that now is the time for clinicians to start talking about costs and how to reduce them.

Changing Attitudes

For many years, doctors didn't even address cost when talking with patients. As Dr. Christopher Moriates, Assistant Dean at the Dell Medical School at The University of Texas at Austin, recently wrote in a column for the Dallas Morning News, the prevailing school of thought was that doctors should be recommending the best course of treatment without "clouding that judgment with considerations of potential costs." 

Many are still hesitant to talk about money. Unfortunately, that mindset must change. Doctors and other clinicians are being asked to take on a more active role in considering the costs of care and discussing the issue with their patients.

But how should you approach a cost-of-care conversation? Here are some suggestions:

• Don't wait for the patient to bring up the issue. Some patients may be too shy or reluctant to bring up the matter of cost, or they may fear they'll get cut-rate care if they express concern over costs.
• Discuss the patient's preferences for their care. Providers shouldn't assume that patients will automatically want a certain type of care. Instead, it's important to find out the patient's own goals for their care or treatment. A patient may not actually want an expensive type of care because it might not line up with their goals. This knowledge can help provide direction for the type of care that they receive.
• Be sensitive to the patient's concerns, including their emotional state. Sensitivity can actually build trust between the patient and  provider, which sets the stage for better interactions in the future.
• Talk about the patient's insurance coverage and out-of-pocket expenses. If you're a provider and you're unfamiliar with your patient's insurance, it's time to ask!

Keep the conversation going. This isn't a once-and-done situation. You may need to keep talking with your patient about costs concerns as time goes on, especially if treatment goals change.

Using Evidence to Make Clinical Decisions

The primary objective of any clinician should be providing the best evidence-based care. However, providing the best care shouldn't be sacrificed due to costs if at all possible. 



Fortunately, clinicians do have evidence-based medical resources to help them figure out how to proceed. The American Board of Internal Medicine (ABIM) Foundation's Choosing Wisely initiative can help guide you in the right direction, providing well-researched recommendations about commonly used tests and treatments—and which ones may not be necessary under certain circumstances. So can EviCore's evidence-based  guidelines. You can also use the guidelines in tandem with information about your patient's medical coverage to create the best possible solution for your patient's specific diagnosis and economic situation. 

Understanding the Challenges

There are still other potential challenges. For example, you may have to educate your whole staff about how to keep the matter of cost in mind, and this can be a culture shift. 

However, it's definitely worth making the effort to at least get the cost-of-care conversation started. As clinicians and patients both begin to feel more comfortable talking about the cost of care, it will become easier. And that's good for everyone concerned about the effect of the cost of medical care on their bottom line.