AMA calls on insurers to provide better cost-estimating tools

When all is said and done after copays, deductibles and coinsurance, patients pay out of their pockets an average 23.6 percent of the amount that health insurers set for paying physicians, according to the American Medical Association's sixth annual National Health Insurer Report Card.

"Physicians want to provide patients with their individual out-of-pocket costs, but must work through a maze of complex insurer rules to find useful information," said AMA Board Member Barbara L. McAneny, M.D., in a statement. "The AMA is calling on insurers to provide physicians with better tools that can automatically determine a patient's payment responsibility prior to treatment."

When cost information is more readily available to doctors and patients, a dialogue can then ensue as to the best way to factor finances into decision-making. For example, doctors can use a deferral strategy for costly services that aren't urgent, such as an MRI for pain that's existed for just a few days. "Tell the patient it doesn't make sense to have this procedure at this time, but it might make sense later. Tell them to come back in a couple weeks, and if it's worse, we'll check it out," Susan Dorr Goold, M.D., a professor of internal medicine at the University of Michigan Medical School who has studied patients' treatment decisions in light of cost, told American Medical News.

Similarly, S. Yousuf Zafar, a gastrointestinal cancer specialist at Duke Cancer Institute, noted in regard to a recent study about cancer patients and bankruptcy that doctors often have the power to make treatment decisions, such as prescribing a pill versus an infusion, that make little medical difference but could ease  patients' financial burden considerably.

"For the most part, it doesn't matter to me," Zafar said. "It comes down to patient preference and cost."

To learn more:
- read the announcement from the AMA
- see the article from American Medical News

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