From cost to care: Your patients can't see the price, and neither can you

The panel agreed patients are putting off care. Where they split was on why, and the disagreement turned out to be the useful part.

Mehta's diagnosis is structural, and she makes it with an analogy that lands harder than it ought to. Walk into a salon and the price of a cut is posted, down to the length of your hair. Call a plumber about a clogged toilet and you learn the call-out fee before anyone picks up a wrench. Health care, she said, asks patients to commit first and find out later.

So she stopped doing it that way. "I have become a hair salon," she said. At the time of the discussion, she said her out-of-network practice posted $300 for an hour-long consultation, $50 for an X-ray and $100 for an injection, and that laying the numbers out is where trust with a patient starts.

The part physicians will recognize is that the opacity runs in both directions. Under high-deductible and mixed plans, she said, the patient cannot see what they will owe, and "not just the patient, the physician has no idea what they're going to be reimbursed."

Jacobs, whose ophthalmology practice carries both insurance-covered and elective self-pay work, described patients moving in opposite directions at once. Some were pushing to get procedures done before the end of the year, worried about losing benefits or facing a larger deductible. Others were slowing down on anything elective, holding onto their money the way patients have in past recessions. Financing options, she said, are what let a patient do both, because they "allow them to hold on to their money while still budgeting and making payments."

Whose job is it to explain what care costs?

Gordon pushed the frame back further. A meaningful share of patients cannot define the words the system uses on them, she said. Some arrive well informed, able to say they have not met their deductible yet. Many more have no idea what a deductible or a copay is. They know only that getting sick is expensive.

"There's not a high school course on how to use your health care services," she said. There is a phone number on the back of a card and terms like authorization that nobody explained. Left alone, she said, that gap resolves badly: patients wait, arrive sicker and begin using the emergency room as a primary care office, which costs more than the visit they skipped.

When she asks client offices whose job the teaching is, her answer is that it falls to the practice by default, because there is nowhere else for it to fall. Transparency, in her framing, is not a courtesy. It removes the fear that keeps people from using coverage they already have.

Lafko moved the problem one step closer to home. Before a patient can be told what care will cost, somebody on staff has to be willing to say the number out loud, and in her experience many are not. She has worked with physical therapy practices where clinicians would recommend three visits a week for six weeks without ever pausing on what that comes to at a $100 copay. "Let's do the math on how much that's going to add up to," she tells them.

The discomfort, she said, is cultural. Raise finances in a clinical setting and the reaction is that the practice has gone corporate, as though acknowledging the business betrays the care. Her argument is that the two hold each other up: the practice is a business so that it can keep delivering care. Which is why she starts with staff training rather than patient education. A team that is uneasy with the subject will not explain it well.

The number was never the obstacle. Saying it was.

Meet the panelists

Pamela Mehta, M.D., is a board-certified orthopedic surgeon in California's Bay Area who has practiced for more than 15 years and owned her practice for about 10 of them. Resilience Orthopedics is completely out of network, so every cost discussion in her practice happens out loud and up front, before anyone is treated. She also co-founded Learn at Pinnacle, which delivers education to women in medicine.

Shawntea "Taya" Gordon, MBA, FACMPE, is CEO of Atlas & Perpetua Healthcare Consulting. She has co-authored two revenue cycle books for MGMA and sits on the association's Government Affairs Council, which means she moves between the granular work of repairing a practice's collections and the policy fights that reshape them.

Carrie Jacobs, COE, is Executive Vice President of Operations at Chu Vision Institute in Bloomington, Minnesota, and runs the practice's ambulatory surgery center. She has spent nearly 25 years in practice leadership, in a specialty where insurance-covered and elective self-pay work sit side by side on the same schedule, and serves on the board of the American Society of Ophthalmic Administrators.

Amy Lafko, MSPT, MBA, spent two decades in health care leadership across acute care rehabilitation, home care, urgent care and medical group practices before concluding that most operational problems were people problems underneath. She founded Cairn Consulting Solutions and wrote "People First: A Proven Method for an Exceptional Healthcare Practice."

The discussion was moderated by Jean Moody, CHPC, Vice President of Specialty and Wellness Solutions at Synchrony, which owns CareCredit. Moody has spent nearly 20 years with the company and ran a LASIK ophthalmology practice before that.

This roundtable was recorded in October 2025.