We were surprised by the number of physicians who said they didnt know enough to properly advise patients, said report co-author Craig Pollack, a physician researcher with the organization that funded the study, the Robert Wood Johnson Clinical Scholars Program at the University of Pennsylvania. He noted that the use of consumer-driven health plans has grown to 5.5 million from 440,000 in the past three years.
Initially, it was thought that it was the healthy and wealthy who signed up for these plans: people who could afford them and may not need a lot of medical care, Pollack said, but now high-deductible plans are increasingly becoming the main option for some patients and doctors need to get up-to-speed quickly on their patients out-of-pocket costs for medications, laboratory and radiology tests, specialist consultations and hospitalizations.
Epperly said that as small business operators, physicians are learning about high-deductible plans the hard way, as they struggle to find adequate healthcare coverage for their practices employees. He said his program has 145 employees and about 60% are now using a high-deductible plan or health savings account.
There is an absolute need for physicians to become smarter about this topic, said Epperly, who added that the residency program he administers is now adding formal lectures on patient costs and integrating the subject into day-to-day medical training. He also said that learning about how these costs affect patients and their ability to adhere to a treatment regimen is a legitimate topic for fulfilling a practicing physicians continuing medical-education credit requirements.
In the course of a 15-minute physician office visit, Epperly acknowledged that discussions about costs can be a deal breaker in terms of time, but he also explained that the physician doesnt necessarily have to be the one who has this discussion with the patient because it could be a member of the practices extended team. He also said that doctors can build the use of pre-printed forms that list the costs of various treatment options into their office visits. Some physicians say If Im not getting paid to do this, why is it my job? Epperly said.
But he noted that these discussions are part of the primary-care doctors care-management duties, and he believes physicians should be reimbursed for it as part of the care coordination they provide under the patient-centered medical home concept.