Caregivers might decide not to discuss the cost of care with a patient because they think getting the person the treatment they need should matter most and the price tag shouldn't stand in the way.
However, not mentioning the financial side of treatment options can be just as potentially harmful to a patient as not telling them about the possible side effects of their medication, says Tara Oakman, PhD, a Robert Wood Johnson Foundation program officer.
"It could end up meaning a patient goes down that road without knowing they have other options," she says. "Maybe they make trade-offs in terms of food or rent, those sorts of things."
Last week, Dr. Oakman wrote a blog post about how educated consumers are the "best" consumers when it comes to creating a healthcare culture that produces optimal outcomes and contains costs. According to Health Affairs, a growing body of evidence concurs with Dr. Oakman, showing patients that have the knowledge, skills and confidence to become actively engaged in their care have better health outcomes. For instance, one study of patients with serious mental illness found that high "patient activation" scores — used to measure their level of knowledge and engagement — were positively correlated with patients' management of their own care and negatively correlated to substance abuse.
Therefore, people need access to reliable, easy-to-understand information about the cost and quality of care in order to make well-educated decisions, which leads to better health for them and less spending for the healthcare system, according to Dr. Oakman. In conjunction with the increasing amount of research demonstrating the necessity of openness, the healthcare industry also faces demand from policymakers, consumers and others to make prices public.
Hospitals have also been experiencing outside pressure to be more transparent about their charges. Steven Brill's TIME exposé, "The Bitter Pill: Why Medical Bills are Killing Us," published March 2013, drew public attention to hospital charges. Then, in May, CMS released hospital chargemaster data to the public for the 100 most common Medicare inpatient diagnostic related groups. In June, the agency also published data from calendar year 2011 on hospital-specific charges for the 30 most common ambulatory payment classifications for hospitals paid under the Medicare outpatient prospective payment basis.
Additionally, policymakers in states such as North Carolina and Oklahoma have passed or proposed laws requiring hospitals and health systems to make their prices public, and it's clear consumers are paying attention to prices too. Earlier this month, a California hospital bill for a $55,000 appendectomy went viral online.
Ultimately, Dr. Oakman says embracing openness about costs and quality will help hospitals and other healthcare providers in their quests to improve care while holding down spending.
"It helps them to deliver better care because they feel better about their work," she says.
Hospitals can inform and engage patients in various ways. Dr. Oakman suggests adopting shared-decision making tools and using the organization's website, reading materials and TV screens throughout the hospital to convey information to patients.
She says those who think "life is so precious we shouldn't have to think about costs" need to realize that way of looking at healthcare ultimately isn't practical.
"The reality is there is a cost, and we do have to think about it," she says. "Making it part of the conversation would be helpful to everybody."
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