Physicians Lack Tactics for Discussing Medical Costs

It’s never easy to talk about financial challenges. But when the topic is avoided when doctors are talking about medical costs, the consequences can be life threatening.

In an effort to quell this issue in the future, a study published recently in Healthy Affairs explores the dynamics between physician and patients when talking about finances. The study examines the question “are physicians prepared to help patients factor out-of-pocket expenses into medical decisions?”

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It’s a topic that becomes increasingly important as patients are saddled with shouldering more of their own healthcare costs. In theory, the increased financial responsibility is supposed to make patients sharper consumers and empower them to trim unnecessary spending.

However, previous study has shown increased costs often lead to people skimping on both valuable preventative care as well as superfluous diagnostic and treatment services.

This study recognizes that doctors could play a key role in helping patients find appropriate, affordable care by talking more about the out-of-pocket costs. But a lot of work would need to be done to achieve this change, according to the study.

“We need to prepare physicians to hold more productive conversations about health care expenses with their patients,” Peter Ubel, the study’s main author and a physician and behavioral scientist at Duke University, said.

For the study, researchers analyzed transcripts of nearly 2,000 physician-patient conversations regarding breast cancer, rheumatoid arthritis and depression treatment. They identified instances in which patients suggested the care might be too expensive and assessed how doctors responded.

Researchers found that overall physicians dismissed patient’s financial concerns, either by not acknowledging them at all or by only half-addressing them.

For example, if a patient pointed out how expensive a drug is, the doctor might ignore the comment completely or might only suggest a temporary solution – like a free trial – without exploring long-term strategies to address the problem.

And, without a long-term plan, patients may eventually stop taking the medication, or take it irregularly. That can harm their health, resulting in a potential costly hospital visit.

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Changing doctors’ behaviors likely won’t be easy, as this is a relatively new aspect to an age-old position. Physicians have not traditionally been taught to listen for patients’ pocketbook concerns, and when they do register, doctors are not accustomed to talking about cost barriers. Many might even think it’s inappropriate to bring up money at all.

Another hurdle for this conversation is that physicians are not always aware of a procedure or medication’s cost. They may be just as surprised as the patient by the high price tag of some drugs and services.

“It’s not as though, ‘Oh, it’s just consumers can’t figure it out.’ Doctors don’t know,” Jonathon Kolstad, an assistant professor of economic analysis and policy at the University of California Berkeley, said. When it comes to figuring out what a drug will cost, “doctors are in the same boat.”

Hospitals Will Pay $28 Million for False Medical Claims

The U.S. Justice Department is cracking down on hospitals found purposefully billing Medicare incorrectly for their own profit gain.

Thirty-two more hospitals located in 15 different states agreed to pay the U.S. government more than $28 million to settle allegations that they billed Medicare for kyphoplasty procedures as inpatient rather than outpatient services to make more money.

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Among the facilities that recently settled are the Cleveland Clinic, which will pay $1.74 million, and five hospitals in the Community Health Systems, which will pay $3.5 million.

These settlements are the latest in a long-running whistle blower lawsuit that alleged Kyphon Inc. encouraged hospitals to perform the kyphoplasty procedures as inpatient rather than outpatient in order to help pay for the kits used in the process.

In all, more than 130 hospitals have reached settlements with the U.S. Justice Department totaling $105 million.

Kyphoplasty is currently considered a minimally invasive procedure used to treat certain spinal fractures often caused by osteoporosis. In most cases, the procedure can be performed safely and effectively as an outpatient procedure without the need of a more costly inpatient hospital admission.

Benjamin Mizer, head of the Justice Department’s Civil Division, emphasized how these purposeful errors “waste the country’s vital health care dollars.”

“The Department of Justice is committed to ensuring the Medicare funds are expended appropriately based on the medical needs of patients rather than the desire to maximize hospital profits,” he said.

All but three of the 32 hospitals that recently settled were named as defendants in the previously filed whistleblower lawsuit. Craig Patrick, a former reimbursement manager for Kyphon, and Charles Bates, a former regional sales department for the company, filed the lawsuit in 2005. The two will receive about $4.75 million for the most recent settlements.

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The government also previously settled with Medtronic Spine LLC, the corporate successor to Kyphon, for $75 million.

The case stands as an example of the importance of regulation and vigilance in the health care sector, an industry where billions are spent annually. It remains important not only for the government to investigate the country’s spending, but also for citizens to be responsible consumers and ask questions about the medications and procedures performed.

Avoid Surprises On Medical Bills By Preparing For Visits

Preparing for a physician visit is the best way to begin becoming a responsible healthcare consumer. Like any transaction, it’s vital that you do research before arriving for your appointment. Similar to when buying large furniture or a car, you will need to know how the visit will be paid for in the end.

The first step before any health provider visit is to verify that your physician, urgent care office, lab location, hospital or other facility is listed as in-network on your plan each time you go to an appointment.

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Primary insurance networks can be altered at any point, especially during this time when there have been so many changes in the industry. That is why it is a best practice to check this information before every appointment.

To check if your doctor or facility is in-network, go to your primary insurance company’s website and use the “Find a Doctor” or “Find a Provider” tool. This tool’s location on the website will vary depending on the primary insurance company.

If you have any problems finding this tool, contact your primary insurance carrier. Contact information will be listed on your primary insurance ID card.

There are also additional steps for preparation if you are visiting a facility or hospital for any procedure. You will need to check with your primary insurance carrier before the procedure to verify your eligibility and to find out if you will need any kind of prior authorization.

Some hospitals and physician offices will check this information before the visit, but that is becoming increasingly rare. It’s best to take full responsibility for this task, as it can directly affect your insurance coverage and therefore your final bill.

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Please contact ClaimLinx by email at phone at 800-858-1772 if you have additional questions on how to prepare for your office visit .