HCPLive Network

Medical Finance Advising No Easy Task for Physicians

If patients are turning to their physicians for counseling on medical finances, they may be cut short by the response…or lack thereof. According to results of a recent survey conducted by the Center for Studying Health System Change, only 48% of physicians say they are comfortable talking about medical budgeting with patients.

The survey results should not surprise anyone, says Christopher Stanley, MD, senior medical director for United Healthcare. “Physicians in medical training have been focused primarily on the clinical delivery of care—what medications to use, what surgeries to do—and have not taken a particularly active role in learning the value of healthcare,” Stanley says. “And one of the components of the value of healthcare is the payment or financing of healthcare.”

The key question is, should physicians be more actively involved?

Unrealistic expectations
Laura Weil, interim director, Health Advocacy Program, Sarah Lawrence College, agrees that physicians often don’t know the finances surrounding the value of healthcare, but she says she’s not sure they can be expected to know. “They don’t know the cost of the MRI that they might be recommending for a patient, nor should they know. And as a matter of fact, they’re prevented by laws like the Emergency Medical Treatment and Active Labor Act from considering—in an emergency situation—whether the cost of treatment is a burden to the patient or the institution. They’re supposed to just look at the clinical indications and prescribe or recommend based on what is going to offer the best care for the patient.”

Weil explains that even if physicians wanted to better understand the value of healthcare, there are considerable barriers to doing so. For example, how can Dr. Smith be expected to know the details of each individual patient’s contract arrangement with his or her health insurer? In addition, the cost of an MRI is going to vary from location to location based on the rate the patient’s insurer has negotiated. Knowing that degree of detail for each patient is not feasible, says Weil.

“How is the physician supposed to keep in his head the price of a procedure for any patient who walks in the door?” asks Weil, rhetorically. “It’s unrealistic. The doctor shouldn’t be tracking costs. Therefore, the doctor can’t possibly advise patients about budgeting for healthcare.”

Give them the tools
United Healthcare’s Stanley agrees that physicians can’t be expected to remember the details of each patient’s health insurance policy, but he says the way to enhance physicians’ comfort level in discussing medical financing is by giving them the right tools to do the job. The insurer’s Claim Estimator, he says, can help physicians determine, in advance of a patient’s office visit, whether a patient is covered for a procedure and the estimated cost of the service.

For example, physicians will typically send in paperwork to determine if a patient is eligible under a particular insurance plan. They’ll try to determine what will be the patient’s responsibility and how much they need to collect from the patient, and whether payment will be in the form of a copayment or coinsurance. It can often take days or weeks for that information to get back to the physician, says Stanley. With the Claims Estimator, however, they can actually get all that information back within 10 seconds.

“It makes the cost and payment information much more transparent and predictable, both for the physician and the patient,” Stanley says. “Every patient and every physician is going to have their own value decision that they’re going to need to make—that they need to make with informed information, with the right tools at the right time. [Claims Estimator] facilitates better purchasing, better treatment decisions, and better value decisions.”

Not a perfect solution
Of course, not every insurance carrier offers a tool like Claim Estimator, and even then, Weil says that, “It’s a mind-boggling idea that you would expect the physician, who is sometimes only getting paid for 3 minutes to talk to the patient, to veer away from the essential clinical nature of the visit to talk about finances. Would that be the best use of a physician’s time and energy? I would rather that my physician be a clinical expert than an insurance expert.”

Stanley says the reactions from physicians and patients in the approximately 15 months since the Claim Estimator has been available have been positive. It may not be a perfect solution, but every tool that enhances the transparent value decision or discussions that take place in physician offices is a step in the right direction. Says Stanley, “Each episode significantly changes the delivery of healthcare.”

Ed Rabinowitz is a veteran healthcare reporter and writer. He welcomes comments at edwardr@frontiernet.net.

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