The Physician’s Role in Today’s Healthcare Costs

By Clive Riddle, July 13, 2018

Influencing consumer behavior to reduce healthcare costs via cost sharing and engagement strategies, and purchaser cost containment strategies of all stripes have seemingly dominated discussions of regarding the cost of healthcare. So how to physicians feel about their role in the cost equation today?

A new seven page NEJM Catalyst Buzz Survey report sponsored by University of Utah Health has just been released: Cost of Care and Physician Responsibility.   The report presents findings from the University’s survey examining how clinicians view health care costs. They “found that while clinicians feel a great sense of responsibility around keeping costs affordable for patients, they don’t feel they have the tools to know, the time to discuss, or the ability to impact how much things costs,” and furthermore “the survey results show a disconnect: Physicians feel responsible for the cost of care to a patient, but not accountable for it,”

99% of surveyed physicians said that out of pocket costs are important to patients – 62% said extremely important, 32% said very important and 5% said important.  Physicians were asked “Do the following aspects of cost enter into clinical decisions at your organization?” 76% said yes to Cost to practice/system; 72% said yes to Out-of-pocket cost for patients; 68% said yes to Total cost of care; and 36% said yes to Contribution to overall national health costs.

How much impact does each of the following stakeholders have on the cost of health care? The percentage of physicians saying each stakeholders had a strong impact were:

•           Pharmaceutical/biotech companies  - 87%
•           Health plans/HMOs/insurers – 81%
•           Hospitals/health systems/physician organizations – 75%
•           Government/regulators – 67%
•           Individual clinicians – 60%
•           Employers – 28%
•           Patients – 26%
•           Medical device manufacturers – 23%

The percentage of physicians agreeing with the following statements were as follows:

•           Health care costs are too confusing with current payer mix – 90%
•           Physicians aren’t trained to discuss the cost of care – 86%
•           The tools necessary to estimate costs to the patient are not available – 78%
•           Tools necessary to estimate costs to health care delivery system, not available –77%
•           There isn’t enough time in clinic to discuss cost of treatments with patients – 64%
•           Physicians should make the best treatment decisions irrespective of cost – 57%
•           Physicians should be held accountable for the cost of care to a patient – 28%
•           It’s not the physician’s responsibility to educate patients about costs – 18%

Current strategies involving physicians are focused at the organizational level, such as with value based care and accountable care arrangements. When you get at the individual level, these survey results indicate that it would seem there is a reason current cost strategies emphasize purchaser and consumer solutions.