Clinicians must address cost, quality of care to reduce spending

As patients gain more control over their healthcare and demand more of a role in the decision-making process, hospitals, doctors and front-line workers must engage them in conversations about cost and quality care matters, panelists agreed during an Institute for Healthcare Improvement discussion Thursday afternoon.

Experts from the Costs of Care initiative, a nonprofit aimed at encouraging providers and patients to lower medical costs, said many physicians and nurses don't know the costs of medical tests--some of which are unnecessary or even harmful--or the repercussions the lack of knowledge can have for both the patient and healthcare spending as a whole for society.

Doctors and hospitals also don't always know how to broach the subject with patients, said Neel Shah, M.D., the founder and executive of the initiative. "There absolutely needs to be a different kind of conversations happening between clinicians and patients," Shah said.

To counteract the trend, some hospitals change the way they train doctors when it comes to talking money with patients. At the University of California San Francisco, Chris Moriates, M.D., a board-certified internist and assistant clinical professor in the division of hospital medicine at the hospital, and colleagues started a cost awareness curriculum program, where interns and other young doctors analyze actual bills sent to patients, trying to find discrepancies and gaps between cost and quality of care. It's clinicians' responsibility to identify overuse and low-quality initiatives within the healthcare system, Moriates said.

Front-line workers, who often have the most access and time spent with patients and family members also have a unique opportunity to discuss cost with the patient at the point of care, said September Wallingford, R.N., a nurse at Brigham and Women's Hospital in Boston. Nurses can keep an eye out for unnecessary tests, and consider whether the plan of care will positively impact the patient, and communicate those concerns professionally with the clinician in charge, she said. Front-line workers should constantly ask, "Does this add value to my patient's care?" she noted.

A cancer survivor herself, panelist Michele Rhee, director of program initiatives, National Brain Tumor Society, recalled being in the hospital and making decisions based on information from doctors, even when they had no idea about the financial impact it could have on Rhee or her family. "How much does this cost? Do we really need to do this? We had this assumption that the doctors knew everything, that the nurses knew everything," Rhee said.

Rhee said patients want to have these financial conversations upfront and the health system will benefit as a whole, when cost becomes part of the inherent process across the care continuum.

To learn more:
- here's the session details

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