How Doctors Feel About Talking to Patients about Finances

During a recent series of focus groups conducted by ideas2scale, groups of primary care physicians, nurse practitioners, and physician assistants were asked, “What is the most notable question patients are asking today that they were not asking three years ago?”

The answer in each of the provider groups was unanimous: Patients are now asking more pointed questions about the cost of treatment, provisions of their insurance coverage, and their out-of-pocket obligations under high-deductible health plans. However, in the majority of instances, patients demonstrated only a cursory grasp of the language of healthcare insurance—deductibles, copays, out-of-pocket costs, in-network vs. out-of-network services, and more.

Typically, questions around healthcare cost and coverage either were brought up during the initial clinical encounter or, more frequently, as patients discovered the amount of the expense for which they were responsible.

“My patients don’t question the clinical quality of the care we provide. They’re worried they can’t pay for it,” one physician commented. Another lamented, “I’m afraid we’re seeing more patients who make the decision not to fill prescriptions because they can’t afford the medicine”—a concern backed by The Commonwealth Fund research. “That only leads to more serious and costly medical issues.”

For the most part, focus group participants indicated they were willing to have conversations with patients and their families around healthcare cost and coverage, but felt inadequately prepared to do so due to the vast array of plans and provisions that exist today

Barriers to Effective Provider-Patient Communications

The stakes are high: Nearly one-quarter of people who have high deductibles cite their deductibles as the reason they have not sought preventive care testing, even though by law, these tests are excluded from deductibles, according to research by The Commonwealth Fund. Lower-income adults delay or avoid care based on their copayments at twice the rate of adults with higher incomes.

However, even among higher earners, out-of-pocket expense is still a factor in adhering to their physician’s instructions: about one out of five adults (21 percent) with incomes at 200 percent of poverty level or higher reported not filling a prescription or delaying needed care due to avoid the expense of a copayment. Such decisions impede physicians’ ability to provide high-quality care.

There are numerous reasons why both physicians and patients and their families might find it difficult to discuss financial issues related to healthcare treatment or services.

For physicians, such barriers include time pressures and lack of knowledge regarding specific insurance plans and coverage limitations. For example, a 2004 study published in the Journal of General Internal Medicine indicated the most common barriers to patient financial communications include insufficient time during the patient encounter, the belief that they did not have a solution to offer, personal discomfort, and fear of giving the wrong impression (e.g., that the quality of care might vary according to the patient’s method of payment).

For patients, barriers often revolve around personal discomfort, reluctance to impose on the physician’s time, concerns about the impact of such discussions on quality of care, and a belief that the physician would not have a viable solution to offer, according to the 2004 study.

April 1, 2021