Improving care

Understanding fees can also help improve care.  Dr. Feldman said costs encompass things like false positives that can be created from ordering unnecessary tests. If you know fees, you may be less likely to order tests that aren’t required.

For example, if a physician orders a PSA test for a patient who does not need it, there is not only the cost of the blood draw and the lab, but if it returns abnormal, the patient is shunted through a system and could get a prostate biopsy and a treatment he might not need. The treatment could be associated with adverse effects such as incontinence or erectile dysfunction.

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Another way that knowing the cost of things can improve care is through better adherence to therapeutic regimens. Cost tends to be one of the major reasons patients do not take prescribed drugs. Physicians may be able to address this problem by prescribing drugs that patients can more readily afford. Additionally, non-adherence may adversely affect patients’ health, which could translate into increased costs to the healthcare system.

“We are trained to do what is medically best for patients and what is medically best might depend on the cost of care,” Dr. Ubel said. “If it is really expensive, a patient might not afford it or skip doses or suffer stress from cost of care.”

Integrating cost

Dr. Ubel worked in the Veteran’s Administration system for 20 years. When new patients came to him, he asked why they switched to receiving care at the VA. Patients commonly said they couldn’t afford their medications. After looking at their list of medications, he almost always found there were comparable generics.

Instead of losing patients, there are ways to understand what your patients are paying for services. Most doctors have no gauge of the cost of services, and this, Dr. Ubel said, is a large part of the problem. “If you have no idea – it could be a billion or zero,” he said.

You might not know the exact dollar amount of each test, but you do know that magnetic resonance imaging costs more than computed tomography. You also know that brand name drugs cost more than generics.

One way to alert doctors to the cost of tests is to put it in the medical records, like the study at Johns Hopkins. When a physician in the active group went into the electronic medical record to order a test, the cost popped up.

Physicians can request to have costs included in their electronic medical records. Even if a company can’t give you an exact price, Dr. Feldman said a good figure is the Medicare allowable charge, which would give you a baseline. If you have a general idea, you can possibly prescribe less expensive tests, particularly if you know a patient is constrained financially.

Further, you may have to begin asking patients if they have financial constraints. If a patient expresses worry about the cost of services, you can refer them to the person who handles billing in your office who can help them figure out options.

“You have to be prepared to have these conversations even if you don’t want to, Dr. Ubel said. “It’s not going to be long before patients will have this information before they come and see you.”