Cost is not the first thing most patients discuss with their doctors. But new research from Duke University's Fuqua School of Business shows it comes up frequently and that a brief conversation could save patients money, often without changing their care plans.
"Almost half the time that costs come up in conversation, either the doctor or the patient come up with some strategy to lower the patient's out-of-pocket cost," Professor Peter Ubel said. "And it doesn't take long, usually less than a minute."
The savings were as simple as doctors suggesting patients look for cheaper pharmacies or try less expensive prescriptions; scheduling follow-up appointments slightly further apart; or arranging expensive procedures when patients had already met their deductibles.
"They're so simple and straightforward," Ubel said.
The findings, "What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1755 Outpatient Clinic Visits," is newly published online in the journal Medical Decision Making.
Ubel worked on the study with Fuqua research associates Christine Kirby and J. Kelly Davis; Duke University School of Medicine students Wynn Hunter and Cecilia Zhang; graduate students Ashley Hesson of Michigan State University and Lillie Williamson of the University of Illinois; and Jamison Barnett of Verilogue, a pharmaceutical marketing research firm. The study was funded in part by grants from the Robert Wood Johnson Foundation and the National Center for Advancing Translational Sciences of the National Institutes of Health.
With the cost of many medical treatments remaining unknown to patients up front, and a 2014 study reporting more than one in four Americans have difficulty paying medical bills, the researchers sought to determine how often doctors and patients discussed costs, and if any cost-saving strategies were mentioned.
The team studied the dialogue from 1,755 outpatient visits recorded by Verilogue nationwide between 2010 and 2014. That sample included 677 patients with breast cancer, 422 with depression and 656 with rheumatoid arthritis, all conditions with potentially high out-of-pocket costs. The doctors were 56 oncologists, 36 psychiatrists and 26 rheumatologists.
The researchers learned that cost conversations were more common than in earlier studies, occurring in 30 percent of clinic appointments. They also found doctors were just as likely to bring up the topic of healthcare costs as patients. In those conversations, almost half involved discussion of how to cut patient out-of-pocket costs.
The cost-reducing strategies that were discussed in this sample included:
- Logistics, such as switching pharmacies or scheduling tests when deductibles had already been met (23 percent)
- Switching to a lower-cost therapy or test (22 percent)
- Using co-pay assistance or drug coupons (21 percent)
- Switching from a brand name drug to a generic equivalent (7 percent)
- Free samples of new medication (13 percent)
- Changing or adding insurance plans (5 percent)
- Changing dosage or frequency of treatment (5 percent)
- Ending treatment (4 percent)
"A lot of doctors are becoming much more aware of the financial stress patients face with healthcare costs. In response, they are being proactive, throwing around ideas that can help patients can figure out ways to get more affordable care," Ubel said. "They're mentioning if a new medicine is expensive, or they're asking if something is covered by insurance. If more doctors adopted this approach, patients could really benefit."