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Financial discussions belong in the doctor’s office

With the Better Care Reconciliation Act and its CBO score in the news, health care and finances are often being talked about in the same breath. The CBO expects average premiums to increase for workers before they decrease, even while out-of-pocket costs increase. Further, as the bill allows states to let health plans quit covering what were previously considered essential health benefits, costs increase even more for consumers.

In the face of changing health care coverage, patients are more conscious than ever of what they pay for a visit to the doctor. According to a group of policy analysts at The Access Project and researchers at Schneider Institute for Health Policy,

A substantial body of research indicates that the uninsured are more likely than the insured to delay or forgo care because of cost, but even the insured may find cost a significant barrier to care. Recent research has documented that, in order to obtain medical care, many individuals are forced into debt, often with serious consequences for themselves and their families.”


If physicians’ main goal is their patients’ well-being, they must consider the harm patients undergo from significant debt:

  • Stress can worsen all types of physical maladies, causing the need for more medical intervention and thus more debt and more stress.
  • Patients trying to save on medical costs may skip essential doses of medicine or doctor visits, worsening their physical health.
  • Patients dealing with debt may find it more difficult to access credit, save money or pay their other bills, causing anxiety and feelings of hopelessness, embarrassment and shame, worsening their mental health.

Thus, a provider’s responsibility to the patient’s well-being includes conversations on costs.


Health care organizations have various options for moving forward with an eye to patients’ financial well-being. Among these options are value-based care, wherein physicians take patients’ preferences into account and are able to provide quality health care at a reasonable price for each patient; and fee-for-service, wherein services are unbundled and paid for separately. When considering those options, health care executives and physicians need to have conversations of their own so they’re on the same page with what is best for patient care and organizational integrity.

In a survey of 2,000 physicians and practice administrators, 56 percent of the high performing practices – based on operational and financial performance – are readying their organizations for the shift to a value-based care model.

In its 2017 US Front Line of HealthCare Survey, Bain and Co. found that more than 70 percent of the 980 physicians surveyed would rather adopt a fee-for-service model than a value-based model. According to Bain and Co., those physicians are not sure that value-based care begets better clinical care, though fee-for-service comes at a higher cost to patients than the other model.

Regardless of the model chosen, physicians can still cut costs for patients. One way to lower patients’ medical bills is to cease ordering unnecessary procedures. Physicians should never order costly tests just to cover themselves. The physician may not always be aware of which procedures will ultimately turn out to be unnecessary, but when the financial harm outweighs the health benefit, physicians should be upfront with patients and let patients make the call on whether to move forward with those procedures.


How does your organization help patients in regards to their financial well-being? We hope you take the time to examine your current position on taking into account the whole patient. As always, we love to hear from you and welcome your input on our posts. Get in touch with us on Facebook to let us know your thoughts!

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