Subspecialists miss opportunities to address patients' financial concerns, study shows
Transcripts of doctor-patient interactions may suggest failure on the part of physicians, but they also reflect a general failure on the part of the health care system, as drug prices and out-of-pocket spending are often difficult to determine.
Patients voice both direct and implied concerns about the costs of their health care, but some subspecialists overlook opportunities to reduce out-of-pocket expenses, according to a recent study.
The qualitative, observational study analyzed transcripts of 1,755 U.S. outpatient, private-practice visits that occurred between May 2010 and February 2014 in the U.S. Results were published in the April Health Affairs.
Researchers obtained transcripts of audio-recorded clinical interactions from the Verilogue Point-of-Practice database for breast cancer (677 oncology interactions), depression (422 psychiatry interactions), and rheumatoid arthritis (656 rheumatology interactions), choosing these conditions because of their expensive treatment options. They excluded visits with primary care physicians, nurse practitioners, and nurses “because these clinicians are often not the ones that prescribed the expensive interventions relevant to the diseases in question.”
With the goal of characterizing, not quantifying, missed opportunities to address costs of health care, researchers categorized physician behaviors into 2 groups: failure to address patients' financial concerns and limited resolution of patients' financial concerns.
In the first group, physician behaviors included failing to recognize potential concerns, allowing their frustration with the health care system to distract from patients' concerns (e.g., complaining about the systemic factors that contribute to high out-of-pocket spending instead of addressing an individual patient's situation), dismissing concerns, and hastily accepting patients' dismissal of their concerns. In the second group, examples included physicians assuming that insurance coverage means full coverage, assuming that generic medications are affordable, assuming that copayment assistance programs and coupons resolve concerns, temporizing financial burden without discussing long-term solutions, and failing to consider less expensive treatments.
While transcripts of these interactions may suggest failure on the part of physicians, they also reflect a general failure on the part of the health care system, as drug prices and out-of-pocket spending are often difficult to determine, the study authors noted. “Consequently, physicians under time constraints cannot be expected to fully resolve patients' financial concerns in the space of any single outpatient appointment,” they wrote.
They also noted limitations of their study, such as how it only involves 3 health conditions, omits longitudinal data of physician-patient relationships, and bears the restrictions of a qualitative study. “[T]he examples we present here cannot be ‘proven’ to be missed opportunities for physicians to help patients reduce out-of-pocket spending. Instead, they stand as snapshots of the kinds of behaviors that potentially lead to such missed opportunities, lacking other efforts to reduce patient expenses,” they wrote.