What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits

Medical Decision Making : an International Journal of the Society for Medical Decision Making
Wynn G HunterPeter A Ubel

Abstract

More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized. We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs. Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively. Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to low...Continue Reading

References

Aug 21, 2003·JAMA : the Journal of the American Medical Association·G Caleb AlexanderDavid O Meltzer
Oct 23, 2003·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Mary Catherine BeachPeter A Ubel
Jun 16, 2004·Cleveland Clinic Journal of Medicine·G Caleb Alexander, Chien-Wen Tseng
Jul 10, 2004·Journal of General Internal Medicine·G Caleb AlexanderDavid O Meltzer
Aug 26, 2004·JAMA : the Journal of the American Medical Association·Chien-Wen TsengCarol M Mangione
Aug 5, 2005·The New England Journal of Medicine·Lars Osterberg, Terrence Blaschke
Apr 11, 2007·Archives of Internal Medicine·Hoangmai H PhamAnn S O'Malley
Oct 20, 2007·Journal of the American Geriatrics Society·Chien-Wen TsengCarol M Mangione
May 6, 2009·Health Affairs·Niteesh K ChoudhryWilliam H Shrank
Jun 9, 2009·The American Journal of Medicine·David U HimmelsteinSteffie Woolhandler
Oct 21, 2009·Health Services Research·Keziah CookAndrew Sfekas
Oct 31, 2009·Arthritis and Rheumatism·Frederick Wolfe, Kaleb Michaud
Nov 26, 2009·Journal of General Internal Medicine·Kate Stockwell FarrellAteev Mehrotra
Jun 16, 2010·BMC Health Services Research·Julie A SchmittdielCarol M Mangione
May 25, 2011·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Alfred I NeugutDawn L Hershman
Jun 12, 2012·The American Journal of Medicine·Leslie R HarroldBecky A Briesacher
Nov 28, 2012·Journal of Oncology Practice·Andrea J BullockMary K Buss
Jul 10, 2013·JAMA : the Journal of the American Medical Association·Christopher MoriatesVineet M Arora
Jul 25, 2013·Journal of General Internal Medicine·Marion DanisElizabeth McGlynn
Aug 30, 2013·The New England Journal of Medicine·Joseph S Ross, Aaron S Kesselheim
Oct 18, 2013·The New England Journal of Medicine·Peter A UbelS Yousuf Zafar
Dec 25, 2013·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Stacie B DusetzinaNancy L Keating
Apr 24, 2014·JAMA Internal Medicine·Kevin R Riggs, Peter A Ubel
May 20, 2014·Journal of Oncology Practice·Christine M BestvinaS Yousuf Zafar
Sep 26, 2014·BMC Health Services Research·Ilana B Richman, Mollyann Brodie
Oct 3, 2014·The Oncologist·Blair IrwinJeffrey Peppercorn
Dec 31, 2014·Annals of the American Thoracic Society·Wynn G Hunter, Peter A Ubel

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Citations

May 20, 2016·Current Hematologic Malignancy Reports·Heidi Russell, M Brooke Bernhardt
Apr 27, 2018·Current Opinion in Urology·Aaron A Laviana, Matthew J Resnick
Aug 24, 2018·Journal of Oncology Practice·Fumiko ChinoS Yousuf Zafar
Aug 31, 2017·Journal of Cancer Survivorship : Research and Practice·Matthew P BanegasK Robin Yabroff
Jul 23, 2020·Clinical Pediatrics·Brinda SarathyCierra Buckman
May 7, 2019·Annals of Internal Medicine·Kimberley S FoxJennifer A MacKenzie
Apr 27, 2018·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·So Young KimJong-Hyock Park
Jun 2, 2020·The Bone & Joint Journal·Walaa AbdelfadeelWilliam J Hozack
Jul 31, 2019·American Journal of Health-system Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists·Aimon C MirandaJulie B Cooper
May 7, 2019·Annals of Internal Medicine·Caroline E Sloan, Peter A Ubel
Mar 21, 2020·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Katrina A FischerJohn Glaspy
Nov 24, 2020·CA: a Cancer Journal for Clinicians·Cathy J BradleyYa-Chen Tina Shih
Jan 27, 2021·International Journal of Clinical Practice·Francisco J BarreraJuan P Brito
May 8, 2021·American Heart Journal·Samuel D SlavinHaider J Warraich
Jul 17, 2021·Seminars in Oncology Nursing·Margaret I Fitch, Christopher J Longo
Jul 14, 2021·JAMA Network Open·Celia C KamathUNKNOWN Shared Decision Making for Atrial Fibrillation (SDM4AFib) Trial Investigators
Aug 6, 2021·Cost Effectiveness and Resource Allocation : C/E·Faride Sadat JalaliSajad Delavari
Aug 18, 2021·Mayo Clinic Proceedings. Innovations, Quality & Outcomes·Nataly R Espinoza SuarezJuan P Brito
Aug 17, 2021·JACC. CardioOncology·Javier Valero-ElizondoKhurram Nasir
Aug 15, 2020·Mayo Clinic Proceedings. Innovations, Quality & Outcomes·Nataly R Espinoza SuarezJuan P Brito
Aug 15, 2020·Mayo Clinic Proceedings. Innovations, Quality & Outcomes·Nandita KheraJoan M Griffin
May 17, 2019·Pediatrics·Colleen L BarryMatthew Eisenberg

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