Sometimes, simply knowing what a test costs can make all the difference.
Many physicians have sheepishly admitted that they know little about the price tags attached to the procedures and tests they order on a routine basis—or how that might impact their patients financially. In Medscape’s Physician Compensation Report for 2012, only 38% of surveyed doctors said they regularly discussed the cost of treatment with their patients. The following year, the rate had dropped to 30%.
One medical resident, Neel Shah, MD, MPP discovered how important those discussions can be.
After a woman admitted to the ED tested positive on a pregnancy test, a follow-up hormone test warned of potential trouble with her pregnancy, and Dr. Shah asked her to return to the hospital for an ultrasound.
“She refused to come in until I could tell her how much the ultrasound would cost,” he recalls. Other providers had told him that bringing up costs with patients would decrease their trust, because they didn’t want doctors to focus on anything but providing care. “With her, it was very clear that my inability to tell her what things cost actually eroded her trust in me and, in her mind, she was being reasonable,” he says.
“If you’re trying to tell doctors or clinicians in general that we ought to be doing things differently, as a young person, it’s not a great way to make friends.”
–Neel Shah, MD, MPP
Dr. Shah had already grown disillusioned in medical school, watching providers around him make clinical decisions without regard to the cost for patients, and he took a hiatus to study politics at Harvard’s Kennedy School of Government. When he and a collaborator subsequently launched the nonprofit organization Costs of Care to point out the downsides of that lack of transparency, however, they received a less-than-enthusiastic reception from some quarters.
“If you’re trying to tell doctors or clinicians in general that we ought to be doing things differently, as a young person, it’s not a great way to make friends,” says
Dr. Shah, who is now an assistant professor at Harvard Medical School in Boston.
The group gained traction as its cost-awareness manifesto began to resonate with the public, however, and the essays on its site have been picked up by multiple media groups. Dr. Shah’s own experience with his pregnant patient, however, made one of the strongest impressions on him.
Getting an answer to her about the cost of an ultrasound took nearly 24 hours, he recalls, “because nobody around me knew.” In the interim, he fretted that his patient might have an ectopic pregnancy and bleed to death. She didn’t, but the outcome could have been very different, he says.
“That really struck home for me, for sure,” he adds. “I think about that all the time.”