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Survey: Most Internal Medicine Residents Are Clueless About Treatment Costs

Results are ‘real cry for cost transparency,’ researcher says

In a cross-sectional survey by the American College of Physicians (ACP), only about 25% of internal medicine residents said they knew where to find cost estimates for tests and treatments and that they can share those estimates with patients, according to an article posted on the HealthLeaders Media website.

The survey questioned more than 18,000 U.S. internal medicine residents who took the Internal Medicine In-Training Examination in October 2012. The study was published in the June 2015 issue of Academic Medicine.

“I was surprised that so few of the residents knew where to find costs of tests and treatments and that so few of them incorporated costs into any clinical decision-making,” said co-author Cynthia Smith, MD, senior physician educator for the ACP. “Patients are picking up more of those costs out of pocket, and so they start to ask ‘what are the relative costs?’”

Smith said that many of the problems in identifying costs stemmed from a sector-wide lack of transparency in health care billing. “This is a real cry for cost transparency and for the billing departments of our hospitals and clinics and insurance companies to be more open,” she said.

The survey also found that:

  • 88% of respondents said they “incorporate patients’ values and concerns into clinical decisions.”
  • 85% said drug overuse was driven by defensive medicine, followed by diagnostic uncertainty (61%), patient demands (55%), and concerns about patient follow-up (47%).
  • More than 66% reported adequate knowledge of the benefits and harms of tests and treatments, offering patients alternatives, considering patients’ values and concerns, and avoiding unnecessary care.
  • 59% said they worked to reduce health care waste in their hospital or clinic.
  • 46% said they “incorporate the cost of tests and treatments into clinical decisions.”
  • 42% said that balancing the benefits, harms, and costs of treatments during patient care was discussed with faculty at least a few times a week.

The ACP has instituted a “high value care” initiative designed to help doctors and patients understand the benefits, harms, and costs of tests and treatment options for common clinical issues so that, together, they can pursue care that improves health, avoids harms, and eliminates wasteful practices.

“It’s not just about saving the U.S. economy because we are spending too much on health care. It’s really about the harm we are inflicting on individual patients when we don’t talk about what the medication is potentially going to cost or if we don’t understand the logistical or financial barriers to care that have a real impact on outcomes.”

Source: HealthLeaders Media; June 25, 2015.


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