As healthcare costs rise, financial concerns are becoming a bigger and bigger factor in many patients' health choices. Unfortunately, many patients don't communicate their concerns to their doctors.
In working to control healthcare costs, opportunities exist to improve physician-patient dialogue in regards to personal finance issues. The increase of out-of-pocket cost has the potential to result in more conscientious use of health resources by patients. However, as patient cost rises it will be important for physicians to be prepared to address these issues and take steps to make them part of the informed decision-making process.
A recent study on physician-patient communication sheds light on missed opportunities that could have potentially resulted in the alleviation of out-of-pocket financial pressures.
1. Failure to Recognize Potential Financial Concerns
Patients tend not to explicitly state their financial concerns, and the study found providers had difficulty picking up on some of these subtle queues and recognizing concern. It would be of benefit to directly address financial pressures as part of the visit through direct questioning. Additionally, the time demands for physicians has increased, to the detriment of the physician's ability to always be fully attentive. Multi-tasking, such as entering electronic health record data while simultaneously holding a complex conversation, was one reason physicians missed these nuanced queues.
2. Distraction from Patients’ Financial Concerns Due to Frustration with the System
In the process of discussing healthcare costs with their patients, providers spent more time on the over-arching systemic complaints or frustration of healthcare cost, than addressing the individual patient’s difficulty to pay for their care and how it could be addressed.
3. Dismissal of Patients’ Financial Concerns
At times, even when physicians did make note of the financial pressures experienced by the patient, they quickly dismissed the issue without addressing it.
4. Hasty Acceptance of Patient’s Dismissal of Financial Concerns
Alternatively, dismissiveness occurred on the patient’s side as well. Patients would voice their own financial concerns and then subsequently dismiss those concerns.
Both physicians’ and patients' dismissals result in a missed opportunity to engage the patient in dialogue for this issue.
5. Limited Resolutions of Patients’ Financial Concerns
There is also limited knowledge as to what resources may be available to address patient concerns about the cost burden of care and thus without an actionable plan providers are less likely to engage in this dialogue.
6. Assuming “Coverage” Means Full Coverage
As more patients opt for high-deductible plans, the assumption by physicians that “being covered” denotes full coverage may lead to patients being burdened by unexpected costs. In some instances, this is true even if the co-payment is relatively low in comparison to others. The patient’s may still be unable to handle the additional cost.
7. Assuming Generic Medications Are Affordable
Industry consolidation has resulted in price increases for some generics, thus rendering them unaffordable for some patients.
8. Assuming Co-payment Assistance Programs and Coupons Resolve Financial Concerns
At times patients were directed to pharmaceutical assistance programs. However, it is important to be aware that not all patients that apply receive assistance and not all that do can afford the cost even after receiving assistance.
9. Temporizing Financial Burden Without Discussing Long-Term Solutions
The use of free samples may be merely delaying the inevitable and obscuring the long-term cost implications of a given treatment. Of note, the availability of samples may result in the patient preferring more expensive pharmaceutical medication once the samples are finished.
10. Failure to Use Less-Expensive Alternatives
The consideration of alternatives has the potential to reduce cost. Prescribing habits may be partly to blame as providers establish preferences and become less likely to consider less expensive alternatives.
In summary, although the study stated its inability to quantify how frequently these interactions occur, it did succeed in framing the issue. These issues will hopefully improve as patients become more aware of how to articulate their concerns and physicians become better armed with solutions to address those concerns. Either way, physicians should seize every opportunity to close the communication gap.