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    How to provide patients the up-front price of treatment


    One of Bullock’s favorite imaging facilities turned out to be costly and no longer gets his practice’s referrals. Bullock says he’s expecting a call soon from the facility’s general manager, asking where the referrals have gone. He’s told his staff to “tell the truth: They’re expensive.”

    The practice had also been sending patients needing colonoscopies to a doctor whom Bullock calls superb: highly qualified, good service, prompt feedback. When they checked his prices on the app, they noticed the costs of the procedure varied significantly between the doctor’s two practice locations. 

    When Bullock’s practice asked about it, the doctor wasn’t even aware of the difference. “We only refer to him at the less expensive location now,” Bullock says. “It let him know we’re paying attention.” That awareness—that physicians and even consumers are watching prices—offers the true potential of price transparency, Kampine says. 

    Bullock estimates his practice has likely saved hundreds of thousands of dollars for patients. Scale that up to every practice in Nashville, in Tennessee, in all 50 states, and the savings will be substantial. “That is the great promise,” Kampine says. “In a free and transparent environment where patients get to see the cost before consuming the service, they will vote with their feet.”

    And when the more expensive providers see their volume diminishing? They’ll have only one choice, Kampine predicts: find a way to lower their prices.


    Ending the taboo

    The price transparency problem may not exist much longer. Silicon Valley has invested tens of millions in data-driven healthcare pricing ventures, including the well-publicized Amino, which lets consumers search and rank nearby doctors using criteria such as patient outcomes and cost. Within months, not years, Shah says he expects a Yelp-like service that will provide consumers with a transparent list of practices’ prices and services. 

    But physicians owe their patients much more than that, he says. Shah advocates not just for price transparency but for doctors proactively discussing costs of care with patients. His passion was ignited a decade ago as a medical student in Providence, Rhode Island, an area with many poor residents. He realized that doctors didn’t seem to consider how their decisions impacted patients’ financial health. 

    Knowing the price of a procedure, thinking about how that price might affect a patient’s financial situation and then weighing the value of it all seemed like it should be the physician’s responsibility, Shah says, but the subject of discussing costs with patients wasn’t being taught in medical school.

    “Not only was I not taught very much about healthcare costs in medical school, but I was actually specifically told that it was not my job to take that into account,” he says. “I think there was a legitimate concern that if you are thinking about costs while you’re caring for patients that you might skimp on necessary care.”

    In reality, Shah says, patients want their doctors to bring up costs. 

    A 2014 survey by CBS News and the New York Times reveals that 80% of adults believe that doctors should discuss the costs of recommended treatment ahead of time.

    So how can doctors broach the topic? Shah urges physicians to screen for financial concerns with simple questions, such as: Are patients worried about healthcare costs? Do they have high-deductible insurance plans? And if patients have financial vulnerabilities, the physician needs to have resources—information on financial counseling, elder care, etc.—available to assist patients.

    With surveys showing that most Americans don’t have enough savings to cover a $1,000 medical bill, physicians need to make a habit of discussing the costs of a treatment plan with patients, Shah says.

    Bullock also knows this is now part of a physician’s job description. To properly fulfill his duty to his patients, he must not only care for physical and mental health but for financial health as well, he says. That is true holistic care, Bullock says.

    “I can’t have tunnel vision and think that price doesn’t matter,” he says. “Of course it matters.” 


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