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Seven Ways to Talk to Your Patients about Cost of Care

Out-of-pocket costs have skyrocketed in the past decade. In 2006, only 4% of people with private insurance were enrolled in high-deductible health plans. By 2018, that number was 29%.

Photo by: Karolina Grabowska

The Senate moved forward last week with The Lower Health Care Costs Act, a sweeping, bipartisan bill that seeks to address surprise medical billing, increase cost transparency, and lower drug prices. For millions of people in this country, such reform is sorely needed: Over a quarter of Americans have trouble paying their medical bills, preventing patients from getting the care they need.

Affordability is hardly a new problem, but out-of-pocket costs have skyrocketed in the past decade. In 2006, only 4% of people with private insurance were enrolled in high-deductible health plans. By 2018, that number had risen to 29%. And out-of-pocket costs pose trouble for publicly insured people, too. For example, Medicare beneficiaries with cancer and no supplemental insurance face average out-of-pocket costs of $8,115 per year. High out-of-pocket expenses are tied to delayed or forgone care, lower adherence, and higher mortality.

Senators are hoping to put The Lower Health Care Costs Act up for a vote before their recess next month. But in the meantime, research from the Annals of Internal Medicine reveals several ways clinicians can help patients navigate the process of paying for their often costly care.

  1. Ask Your Patient

Many physicians report initiating cost-of-care conversations only when they sense patients are struggling financially, relying instead on “clues” like poorly controlled symptoms or care delays. That’s a problem since patients with affordability concerns are often reluctant to bring them up. Consider it part of your job to screen for financial hardship.  

  1. Discuss Cost Prognosis

Practitioners are charged with providing patients with as much information as possible about their treatment, which should include cost. Multiple studies show that patients want regular cost-of-care conversations. While physicians sometimes worry that talking about financials might deter patients from seeking or pursuing care, the opposite is often true: Cost-of-care conversations enable patients to better plan for expensive treatments, which can increase their adherence.

  1. Anticipate Costs

Physicians often dismiss cost-of-care conversations because of the difficulty of predicting the costs of procedures, diagnostic tests, and drugs. But, according to one study, many patients are mainly concerned with the indirect costs of appointments, such as transportation, child care, and lost income. Many of these costs can often be anticipated and planned for as long as doctors are willing to have frank conversations with their patients.  

  1. Make Cost-of-Care Conversations Systematic and Routine

Incorporating a cost-of-care conversation screening system into staff workflow can help determine the existence of financial hardship, alleviate the shame many patients feel about their financial difficulties, and clarify who patients feel most comfortable speaking to. In one study where such a system was implemented, providers became more comfortable having cost-of-care conversations, and patients became less concerned about the costs themselves.

  1. Find a System That Works for You

There are multiple ways to integrate cost-of-care conversation into your practice. In one study, for example, clinic staff suggested three effective methods for doing so: Charging a single staff member to solve out-of-pocket cost problems so they can develop expertise and efficiency; using the electronic health record (EHR) to document patients’ financial needs; and using the EHR to collect available data on costs and insurance coverage. Trial and error can help determine the best strategies for you and your team.

  1. Get Your Staff Involved

As important as developing a system for cost-of-care conversations is, practitioners don’t always have to take the lead. Other staff — medical assistants, financial counselors, and administrators — can be equally effective. Studies show that many patients are happy to speak with ancillary staff about costs.

  1. Practice Makes Perfect

Studies show that clinicians get better at cost-of-care conversations the more they have them. Moreover, they also consider costs more often when making medical decisions, and those who use online tools, such as, develop expertise with them.

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