Executive and clinician respondents to a new NEJM Catalyst survey said knowing out-of-pocket costs is important to patients and more than 60% said physicians are responsible for educating patients about these costs. However, nearly half don’t think physicians should be held accountable for those costs.
Slightly more than three-fourths of respondents said their organizations consider the cost to the practice and system when making clinical decisions. A slightly lower number (72%) said they consider patient out-of-pocket costs, while 68% said they think about the total cost of care.
Respondents said the stakeholders that have the biggest impact on healthcare costs are pharmaceutical/biotech companies (87%), health plans (81%) and hospitals/health systems/physician organizations (75%). Only 28% pointed the finger at individual clinicians and even fewer blamed employers (26%) and patients (23%).
These results show that thought leaders believe physicians should play a role, but shouldn't be penalized for the actual cost of care. Plus, other healthcare stakeholders are encouraged to improve processes and tools to better educate patients on costs.
The findings come as more payers are pushing providers into value-based contracting. The different payment method incentivizes and penalizes physicians and health systems to keep costs under control and provide a minimum level of care quality. The concept behind value-based payment does include holding doctors accountable for costs to an extent.
Meanwhile, payers and employers have shifted more healthcare costs onto patients. That was evident in Mercer’s recent National Survey of Employer-sponsored Health Plans. The report found that employer health insurance costs are increasing at a slower pace than a decade ago, partly because of cost shifting to individual enrollees. Also, patients and members spend more out-of-pocket costs and see higher deductibles.
In response to that shift, some systems, including Intermountain and Geisinger, are investing more to focus on patients in the revenue cycle. Health systems and providers are creating consumer engagement programs, payment plans and healthcare financing.
The problem of rising healthcare costs isn't ending anytime soon. In fact, Mercer warned that the expected increase of uninsured Americans will drive prices up further in the coming years.
The University of Utah Health commissioned the Value in Health Care Survey to explore how patients, physicians and employers perceive value. The university partnered with NEJM Catalyst to administer three surveys focusing on cost, quality and service.
This new survey asked questions to members of the NEJM Catalyst Insights Council, which includes executives, clinical leaders and clinicians, about their insights. The respondents highlighted multiple hurdles for getting cost data to patients and health systems. These issues involve payers, physicians, tools and time.
Nearly all respondents (90%) said healthcare costs are too confusing in the current payer mix, 86% said physicians aren't trained to discuss costs and 78% said cost-estimator tools aren't available for patients. Also, 77% said those tools aren't available to health systems. Nearly two-thirds (64%) said there isn't enough time for clinicians to discuss costs of care with patients.
Though 28% of respondents said physicians shouldn't be held accountable for the cost of care, only 18% agreed that it’s not the provider’s responsibility to educate patients about costs.