“When it's the same information presented from a number of sources, it's more trusted,” says Leah Binder, CEO of the Leapfrog Group, whose organization gives hospital quality rating information to large healthcare purchasers for them to offer to their patients.
While physicians and other providers generally support the concept of discussing quality of care with their patients, research suggests they are reluctant to discuss costs. A survey of physicians published in the Journal of the American Medical Association in July found only 36% of physicians believe they have a “major responsibility” for reducing healthcare costs; they assigned greater responsibility to plaintiff lawyers, insurers, hospitals, drug and device manufacturers, and patients (52%).
There are good reasons for physician wariness about cost discussions with patients, says Harold Luft, director of the Palo Alto Medical Foundation Research Institute. Luft says consumers need a broadly accepted quality measure that clearly demonstrates that higher costs don't necessarily mean better quality. Lacking such a measure, most consumers assume that more expensive providers, products and services are better and that doctors who refer them to less-expensive care are doing so for their own financial benefit.
“We need better objective data,” Luft says.
Physician use of quality data also may be limited by the complexity of referral situations, says Wendy Lynch, co-director of the Center for Consumer Choice in Health Care at the Altarum Institute. For example, physicians looking at price and quality comparisons for a patient's referral surgery need to take into account the separate cost and quality ratings for the surgeon and the hospital.
“It's really hard to pull these things apart,” Lynch says.
Patients also may be resistant to cost discussions. Dr. Susan Dorr Goold, a researcher and internist in the University of Michigan Health System, Ann Arbor, co-authored a February study in Health Affairs that used focus groups to gauge patients' reactions to physicians raising the issue of cost when discussing their care options. Reactions ranged from skepticism to hostility.
“Patients didn't have a great interest in cost,” Goold says. “I was surprised how vehement they were.”
Additionally, patients might not be open to cost and quality discussions when they are suffering from painful or debilitating conditions, Luft says. In such cases, physicians may be better off synthesizing the cost and quality data themselves and recommending a course of action to their patients.
“If I'm the patient, I want the physician to roll all of that information together (so I don't) have to make that decision in that situation,” Luft says.
But patient interest in prices appears to rise sharply when they are responsible for a larger share of the cost. For instance, UnitedHealthcare members enrolled in high-deductible plans are “much more inclined” than those not in such plans to use the insurer's cost estimator, Bogatyrenko says.
The financial pressure of high-deductible plans might increase the importance of clinicians in helping patients make decisions based on cost and quality, Goold says. “The problem with the concept of patients having 'skin in the game' is that patients are not good at deciding where to put their money.”