It is often the elephant in the room in a patient encounter. The physician tells the patient that they require a battery of tests or long-term treatment with a prescription medication. The patient is thinking: How will I pay for this? Can I afford it?
“That has a tremendous impact on adherence and following through on treatment plans,” says Wendy Nickel, MPH, Director of the Center for Patient Partnership in Healthcare, American College of Physicians (ACP).
Physicians should not be afraid to discuss finances with patients, said Nickel, who gave a presentation on the out-of-pocket costs of care at the ACP Internal Medicine Meeting 2018 in New Orleans, Louisiana.
Unfortunately, the conversation is not happening often enough, Nickel said in an interview with Patient Care.
According to one survey published in JAMA1, 79% of internists believed that patients wanted to discuss out-of-pocket costs, and 63% of their patients agreed. However, only 15% of patients said they had ever discussed those costs with the physician.
“As a physician, I need to acknowledge the fact that this is impacting my patients, but it is also impacting the care that I recommend,” says C. Jessica Dine, MD, Senior Fellow at the University of Pennsylvania Leonard Davis Institute of Health Economics, Philadelphia. “If I recommend something and a patient can’t afford it, it’s not going to happen.”
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1. Caleb Alexander G, Casalino LP, Meltzer DO. Patient-physician communication about out-of-pocket costs. JAMA. 2003;290:953-958.
2. Frankel RM, Stein T. Getting the most out of the clinical encounter: the four habits model. J Med Pract Manage. 2001;16:184-191.
3. Keller VF, Gregory Carroll J. A new model for physician-patient communication. PEC. 1994;23:131-140.