Poor Physician-Patient Communication Leads to Higher Out-of-Pocket Spending

A new qualitative study of clinical meetings between physicians and patients pointed out certain behavioral concerns that stand in the way of helping patients navigate out-of-pocket spending. The study, published in Health Affairs and led by Peter A. Ubel, MD, with fellow researchers, found that for optimum utilization of consumer healthcare markets, physicians need to be prepared to help patients navigate out-of-pocket expenses during clinical encounters.

Most of the failures resulted from systemic barriers to healthcare spending conversations, such as a lack of price transparency. Some behaviors reflected a failure to fully engage with patients’ financial concerns—from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending.

Study Method and Results

For the study, the researchers analyzed patient-physician interactions for breast cancer, depression, and rheumatoid arthritis. Only these 3 medical conditions were chosen for the study because they often involve expensive healthcare interventions that could lead to high out-of-pocket expenses.

Excluded were visits conducted by primary care physicians, nurse practitioners, and nurses; visits conducted outside of United States; and visits involving patients younger than 18 years. The final sample consisted of 1755 visits: 677 breast oncology, 656 rheumatoid arthritis and 422 psychiatry. All visits occurred between May 2010 and February 2014.

The physician behaviors that led to missed opportunities to reduce out-of- pocket expenses were divided into 2 broad categories:

• The physician’s failure to address the patient’s financial concerns, meaning they didn't make an explicit effort to acknowledge the seriousness of the patient’s concerns
• Instances where physicians did make explicit efforts to deal with patients’ financial concerns but failed to resolve them satisfactorily

Sometimes, patients explicitly mentioned their financial troubles, but physicians failed to give it complete attention because of clinical distractions. Many physicians get too involved in entering data into electronic medical records or examining patients that they tend to overlook unexpected and observational issues such as patient financial concerns. In other cases, when physicians do understand the patients’ money problems, they dismiss the possibility of solving it for the patients.

A misunderstanding of the term “coverage” can also leave patients with co-payments or co-insurance. Physicians can mistakenly assume that “coverage” means full coverage and unintentionally end up exposing patients to burdensome out-of-pocket spending.

Physicians Need to be More Actively Involved

Due to certain behavioral limitations and assumptions on part of the physicians, they fail to reduce patients’ spending. The study does not place any blame on physicians but highlights certain areas that could cover up for the missed opportunities. The researchers add that physician-patient communication is a 2-way street and sometimes patients fail to express their issues clearly.

“Nevertheless, it is still incumbent on physicians to do their best to overcome patients’ difficulties communicating about their expenses,” the authors concluded.