Study: Doctors considering care costs in treatment plans

As greater numbers of patients have difficulty paying for their medical care, doctors are paying more attention to care costs when developing treatment plans. And while physicians are more willing to discuss cost issues with patients than in the past, many still have difficulty doing so.

Those findings emerge from a recent study examining how patient out-of-pocket costs affect physicians’ treatment decisions, and the factors that doctors consider when deciding whether and how to discuss care costs as part of a treatment plan.

Patients’ shares of their medical costs have been escalating rapidly in recent years due to rising insurance premiums, deductibles and copays, and the popularity of high-deductible insurance plans.

The authors obtained data for the study by surveying 621 internists and conducting in-person interviews with 20. Among their findings:

• Whereas 75 percent of respondents said they now consider out-of-pocket costs when making most clinical decisions, only 50 percent said they had frequent discussions about costs with patients.

• Three-quarters of study participants said they knew of a patient taking medicine in smaller doses or less frequently than prescribed during the past year because of cost, and 90 percent knew of a patient not filling a prescription.

• Eighty-four percent of participants reported knowing of patients going without medical care during the previous year because they couldn’t afford the tests, treatments or follow-up care. 

• About three in 10 participants said there had been times during the previous year when they wanted to discuss out-of-pocket prescription drug costs with patients, but didn’t.

• Among participants who reported frequent cost conversations with patients, 69 percent said that cost to the patient was the most important factor when deciding which drug to prescribe, compared with 56 percent for those who did not discuss costs with patients frequently.

The authors note that a problem doctors often encounter in cost discussions is patients’ hesitancy to bring up the subject out of embarrassment or deference to the doctor. Therefore, doctors have to rely on clues such as nonadherence or delaying care to determine whether a problem exists.

And while survey participants rarely knew the exact out-of-pocket cost to a patient of a specific treatment or medication, they were usually able to offer general explanations of potential costs and help patients through processes to get coverage for medications, treatments and services, or at least reduce their costs.

The study, “U.S Internists’ Perspectives on Discussing Cost of Care with Patients: Structured Interviews and a Survey” is part of a supplement to the May 7, 2019 issue of Annals of Internal Medicine.