Healthcare costs and the promise to “do no harm”

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Through no fault of their own, physicians are acutely unaware of the costs borne by their patients. Regardless of their experience in providing healthcare services, less than 1 in 5 physicians and approximately 1 in ten residents were able to provide a price estimate within ±25% of true values across all surveyed costs, charges, and reimbursements.

Physicians are here to help and understand that costs have a material impact upon health and wellbeing. The mission can not be done alone. Collaboration with patients, practices, health plans, and policy is needed with physicians in order to support price transparency in healthcare.When patients’ out-of-pocket spending concerns were revealed, price information helped them engage patients in conversations about how to alter treatment plans to make them more affordable. Many PCPs contend that physicians bear the chief responsibility for discussing prices with patients because of their clinical knowledge and relationships with patients.

Making price information available can motivate physicians to reconsider the value of the services they provide or recommend and to reduce the amount of inappropriate tests or procedures they order. This means that a greater share of adults who have previously reported barriers to accessing medical care because of costs will receive the necessary care they need when they need it. As aptly pointed out by Lisa Rosenbaum, MD, and Daniela Lamas, MD, "Put simply, helping a patient become well enough to climb the stairs to his apartment is meaningless if our care leaves him unable to afford that apartment… Protecting our patients from financial ruin is fundamental to doing no harm."

Physicians and patients judge communication about healthcare costs to be important and to have the potential to influence health and financial outcomes; however, discussions between physicians and patients on the topic are rare. As a result of the Transparency in Coverage Rule, those discussions will be happening more frequently. And that’s because, as of January 1st, 2024, patients receiving employer-sponsored health insurance coverage or those enrolled on the individual marketplace (~200M+ Americans) are equipped with a web-based cost-comparison shopping tool. This tool highlights the patient’s out-of-pocket exposure and underlying negotiated rates based upon the patient’s plan design, upstream network arrangements, benefit accumulators, and claims. All procedures and services are searchable within the tool, along with the hyper-personalized display of procedure-provider pricing. No longer are price ranges and chargemaster rates acceptable forms of potential payment obligations, as these rates are not compliant with the Rule and bear little resemblance to the costs actually incurred by patients.

Talk to your patients about price transparency

With the passage of January 1st, 2024 and the web-based cost-comparison tool now available, physicians should ask their patients:

• Are you aware of the radical price variation that exists between in-network providers for the same exact procedure?
• Are you aware that your employer or health plan should have provided you within a cost-comparison shopping tool so that you can navigate to cost-effective care?
• How can I make sure that you receive the necessary medical care you need to be made whole but don’t end up with insurmountable debt obligations?

These sorts of questions and the resulting conversation lead to meaningful patient-physician engagement, increased trustworthiness, and growing compassion within the healthcare environment. It’s not cost-consciousness, it’s practicing patient-centered care ethically.

Mark Galvin has been a thought leader and staunch advocate for price transparency and consumerism in healthcare for more than 17 years. He co-founded TALON in 2014 to create and supply a platform supporting a more competitive, efficient healthcare marketplace.