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General interest items edited by Janice Flahiff

[Repost] Policy: Doctors Urged to Talk About Costs of Treatment & A Related Personal Story

Flashback— About 20 years ago I was in an urgent care center around 11 pm with a severe migraine.  The doctor was getting ready to give me a shot with appropriate medication.  At the time I was unemployed with little money. So I asked him if I could get a prescription for capsules/tablets instead, and how much the shot would be. He looked a bit startled, but looked up the information for me.  I opted for the capsules/ tablets. My mother, bless her, drove me to a nearby hospital so I could get the prescription filled. Was very grateful the medication kicked in within 10 minutes or so. Will never forget the compassionate professionalism of that physician.

Flashback II – About 25 years ago I had rather painful wrists (not carpal tunnel) and went to a doctor.  (From a temp job, basically keyboarding for hours at end.) Again, I was uninsured with little money.. Went to the doctor with a book from the library with exercises to relieve pain in the wrists.  Asked the doctor what he thought about them.  Told him I was uninsured and didn’t have much money. The doctor didn’t say much. Just directed me down the hall to a physical (occupational?) therapist.  The therapist gave me several pages of exercises and went over them with me.  I asked her what the additional charge for her services was. She said nothing.  Again, the doctor showed compassionate professionalism. Such a “business” where the staff communicated well and worked with each other for the customer’s benefit!  Oh, and the exercises worked, and I keyboarded with better ergonomics as outlined in the handouts given.

From the 18 October 2013 article at Concierge Medicine Today

by David Pittman, Washington Correspondent, MedPage Today

Oct 16, 2013 – Physicians need to broach discussions about out-of-pocket costs with patients the same way they discuss a treatment’s side effects, public policy professors wrote.

“Admittedly, out-of-pocket costs are difficult to predict, but so are many medical outcomes that are nevertheless included in clinical discussions,” Peter Ubel, MD, of Duke University’s School of Public Policy, and colleagues wrote.

They noted in a New England Journal of Medicine perspective published Wednesday that patients can experience considerable financial strain from out-of-pocket costs, with little or no discussion beforehand about potentially avoidable health-related bills.

“Because treatments can be ‘financially toxic,’ imposing out-of-pocket costs that may impair patients’ well-being, we contend that physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments’ side effects,” the authors wrote.

They gave the example of a colon cancer patient who receives bevacizumab (Avastin), which can help prolong life by 5 months over chemotherapy alone.

Many providers don’t mention that the drug can cost $44,000 for 10 months of therapy, Ubel and others wrote. A Medicare patient responsible for 20% of the cost can expect $8,800 in out-of-pocket costs on top of other treatment costs, doctor’s fees, and diagnostic tests. The out-of-pocket costs can be even higher for patients with high-deductible insurance plans.

“Most physicians insist on discussing the 2% risk of adverse cardiovascular effects associated with bevacizumab, but few would mention the drug’s potential financial toxicity,” the authors noted.

More than one in five patients covered only by Medicare (20.9%) reported some kind of financial burden, according to the National Center for Health Statistics data the authors cited. Even 30.4% of privately insured patients under age 65 reported some financial burden from medical care.

The authors suggested that taking the time to discuss what can be an uncomfortable topic may:

  • Enable patients to choose lower-cost treatments when available
  • Help patients who are willing to trade medical benefit for financial distress
  • Enable patients to seek financial assistance earlier and avoid duress

In addition, evidence suggests that considering costs as part of clinical decision-making might reduce long-term costs to society, the authors noted. For example, some physicians feel it’s their responsibility to provide the best care regardless of costs, and patients worry that inquiring about prices will pit them against doctor’s orders and open them to subpar treatment.

Physicians lack training in this area, and may feel uncomfortable or may not know what a patient’s costs will be since it depends on what health insurance plan they have. “It is often difficult to determine a patient’s out-of-pocket costs for any given intervention,” Ubel and colleagues wrote.

But insurance companies are developing ways to better estimate patients’ costs, the perspective stated. Furthermore, policymakers need to push for greater price transparency, especially when it comes to prices borne by patients.

“We can no longer afford to divorce costs from our discussion of patients’ treatment alternatives,” they wrote.

October 19, 2013 - Posted by | health care | , , , ,

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