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As Healthcare Costs Increase, Cost-of-Care Discussions Can be Make or Break for Patients

March 12, 2019

Healthcare spending has reached astronomical figures, exceeding $3 trillion a year and straining the budgets of patients, according to CMS. Over the past decade, the percentage of patients who spend $1,000 or more out of pocket for healthcare each year has increased from 17 to 24%. Rising healthcare costs are no secret—not to providers, not to health plans and not to patients. But those costs are rarely discussed openly with patients.

CMS Transparency Rule Is a Good First Step

The CMS price transparency rule—which went into effect January 1, 2019—requires all hospitals to make their chargemasters public so that patients can access a list that details the costs of every procedure, test, drug and service provided by the hospital. The goal is to increase cost transparency and empower patients to have more autonomy regarding choices pertaining to their health and the care they receive. But listing the prices is just the first step in achieving cost transparency.

Most chargemasters are difficult to understand. Moreover, patients need to know how much of that charge they will be expected to pay, and, if paying for services is a hardship, what options they have for managing the cost. Further complicating the issue is the fact that many costs may be unknown until after discharge. For patients to better grasp the expected costs, a conversation—probably many conversations—with the clinician and other hospital employees must take place.

Research into Cost-of-Care Discussions Reveal Key Themes

According to a report from the Public Agenda and the Robert Wood Johnson Foundation (RWJF), while 70% of Americans say they would like to discuss the costs of their care with their clinicians or other medical staff, only 28% report doing so. The reasons these conversations fail to take place are varied. To start, the total cost of care encompasses are wide array of costs, ranging from how much a patient may pay out of pocket for a certain procedure or medication to how much it may cost to drive to appointments or pay for child care to the loss in salary a patient may face if they are unable to work. Another RWJF poll found that 42% of patients simply wait until receiving a bill to address costs of care, which is too late for informed decision making and certainly too late to address or plan for such costs.

To support research and the development of resources to encourage conversations about costs of care between patients and those providing their care, in 2016, Avalere partnered with RWJF to research the barriers encountered around patient-clinician cost-of-care conversations. Some important themes emerged from this research:

  • Discussing cost of care does not necessarily add a significant amount of time to visits: This finding is important because lack of time is often cited as a reason for not having cost-of-care conversations. In fact, having these conversations up front can save time by preventing follow-up calls or medication adherence issues stemming from the high cost of a medication.
  • Patients will likely wait for providers to introduce the subject of cost: Many patients are hesitant to ask their clinician about costs, feeling that it is unacceptable or uncomfortable to ask about costs.
  • Nearly all patients have cost concerns: Concerns about cost span the gamut of patients—regardless of insurance status—and include concerns about the cost of care as well as indirect costs associated with receiving that care.

Avalere Podcast Series: How to Talk to Patients about Costs of Care

To help clinicians improve the quality and frequency of cost-of-care conversations with patients, Avalere, with support from the RWJF and the New York State Health Foundation, recently produced a four-part podcast series:

Episode 1: Why Should Primary Care Clinicians Routinely Talk with Their Patients about the Expected Costs of Care?
Episode 2: Quick Tips for Clinicians on How to Talk with Patients about the Expected Costs of Care
Episode 3: A Guide to Integrating Cost-of-Care Conversations into Workflow
Episode 4: Recommendations for How to Overcome Common Barriers When Implementing Cost-of-Care Conversations

Understanding healthcare costs is no easy task—and neither is explaining those costs to a patient. The ultimate goal of any healthcare provider should be to deliver high-quality care, and discussions about how much that care will cost is playing an increasingly important role in care delivery in terms of both patient engagement and satisfaction. Exploring patients’ concerns about cost helps make the patient an active participant in their care—an important step in the right direction toward providing the patient-centered care today’s healthcare leaders are seeking.

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