When It Comes to Cost, Doctors Are Caring But Clueless

When it comes to the costs of what they order, doctors are caring but clueless. That's a big problem given that about 3/4 of the cost of care comes from the doctor's pen, mouse, or mobile device.

But, changing patient and doctor behavior is the Holy Grail.

However, here are 10 ways that could help doctors order less expensive tests and procedures:

1. Drive out unnecessary care. There are many reasons why there are unnecessary medical visits. Some have to do with the doctor, some have to do with the patient, and many have to do with a system that rewards them.

2. Put a price tag on everything that they order. Why is this so hard? Because 1) medical cost accounting is archaic and most MBAs couldn't tell you what something costs to deliver, 2) they would have to use different business model that they would find to justify in the board room and 3) they don't want to kill the cash cow.

3. Create incentives to follow evidence based care guidelines. Many doctors don't do what they are supposed to do and do what they are not supposed to do for many reasons.

4. Tell patients no when they demand ineffective tests and treatments. I'm sorry, but the patient is not always right.

5. Create rewards and principles of behavioral economics. We need to do a better job of altering how we respond to change.

6. Monitor and eliminate perverse triggers e.g. inappropriate use of prophylactic antibiotics in the perioperative period

7. Compare them to their peers

8. Address the underlying causes of Type 1 and Type 2 technology adoption errors

9. Make conflict of interests transparent. Physician entrepreneurs are viewed with suspicion because patients often think those doctors have conflicts of interest (COI), i.e. they place something else, most often financial again, ahead of the patient's interest. There are many sources of conflicts of interest that are less apparent than doctors receiving money from digital pharma/medtech companies, such as cultural or religious beliefs, political affiliation, or even the teams they support on Sundays.

10. Get a second opinion on second opinions and tumor boards. In many instances, patients or payers don't want a second opinion; they want a second doctor.

Patients are paying more and more out of pocket and being charged with being better consumers of care and looking for sources of information about quality, price and value. Unfortunately, their doctors won't be much help.