Dollars and sense: Helping patients understand the cost of health care

Since 2009, the number of American patients with high-deductible health insurance plans increased by 60% to nearly 37% of insured patients, according to Business Insurance. These patients—and others concerned about the costs of medical care—are turning to their physicians for assistance with navigating health care costs and avoiding unnecessary spending, says Jim Hess, EdD, the chair and director of the Oklahoma State University School of Healthcare Administration.

“Patients enrolling in health insurance plans are faced with a lot of decisions. How much should they put in their health savings account? Do they want a low deductible or a high deductible?” says Dr. Hess, who teaches a required course on the business of practice management to medical students at the Oklahoma State University College of Osteopathic Medicine in Tulsa. “More and more, patients are looking to their physicians for guidance.”

But not all physicians are trained to navigate these questions in medical school or residency, notes Paige Gutheil Henderson, DO.

“Traditionally, physicians have worked to keep the conversation around medical care separate from cost of care. We never want patients to feel that cost influences our decision-making at the expense of their health,” says Dr. Gutheil Henderson, an associate professor of primary care medicine at the Ohio University Heritage College of Osteopathic Medicine in Athens. “It can be a tricky conversation.”

Physicians and health care experts share the following tips for helping patients navigate the costs of health care.

1. Whenever possible, encourage patients to call hospitals and their health insurance company to make sure they know the exact cost of a procedure, Dr. Gutheil Henderson suggests. Not only does this help patients reduce their health care spending—it can also prevent patients from forgoing treatment when they believe it is too costly, but don’t know the actual cost of a procedure.

2. Physicians—and patients—can gain greater insight into health care costs by requesting a copy of hospitals’ charge master lists, says Dennis Paradis, MPH, who teaches health care policy at Michigan State University in East Lansing. Like a restaurant menu, a hospital’s charge master list details what the hospital charges for every procedure.

“Physicians should know the cost of procedures at their hospital and other hospitals in the area,” Paradis says.

3. Facility fees are a growing problem in health care, Paradis says. A facility fee is an extra fee tacked onto a patient’s bill in addition to the doctor’s visit fee; some hospitals charge them to support their overhead.

“If a doctor’s office is going to include a facility fee, the patient should know that up front,” he says. “There’s obligation on the part of the physician to say, ‘In addition to paying my fee, you’ll be charged a facility fee, which the hospital gets for supporting my practice.'”

4. When prescribing drugs, advise patients to cost-compare using websites such as GoodRx.com.

5. When proposing a treatment plan, ask patients for feedback. This will give them the opportunity to bring up financial concerns, Dr. Gutheil Henderson says.

6. Familiarize yourself with the different insurance plans available to your patients, and develop an understanding of how they work, recommends Dr. Hess.

7. When answering insurance questions, do not tell patients which plan to choose, Dr. Hess says. Instead, help them get the information they need to make an educated decision.

“Advise patients to honestly assess their own health status and health care usage and to be cognizant of their genetic predispositions for chronic diseases and other illnesses,” Dr. Hess says. “The patient should then pick the best high-deductible or low-deductible health insurance plan based upon that honest assessment.”

8. Many physicians can set up their electronic health records system to show the cost of different procedures and how much the insurer and patient will pay, Dr. Hess notes. The ‘physician’s view’ in the EHR system doesn’t always default to providing this information.