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Doctors and patients are discussing ways to cut costs

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Many people might find it awkward to bring up money with their doctor, but a new study finds that physicians and patients are talking about health care costs in about one-third of office visits, and that nearly half of those conversations focus on ways patients could save money. 

"With surprising frequency, doctors and patients are talking about health care costs during clinical encounters," says Dr. Peter Ubel, a Duke University professor and one of the authors of the study, published last month in the journal Medical Decision Making.

Though doctors were not traditionally taught to consider the cost of care, the study finds that they initiated about 58 percent of the cost conversations.

"I think the doctors are bringing it up because they see a lot of patients suffering," Ubel says. "They've had enough patients complain about costs. They're more aware of it; their antennas are up for the problem."

The lack of price transparency in health care is a major barrier to people shopping for affordable health care. Oftentimes, neither doctors nor patients know how much a medication or procedure will cost.

The lesson from this new study is, "even if you don't know exactly what something costs, or exactly what something will cost a patient, with a short conversation you can do something to save the patient money," Ubel says. 

Ubel says past research on discussions of health care costs were conducted as surveys. For this study, Ubel and his colleagues analyzed transcripts from 1,755 outpatient clinic visits between 2010 and 2014. They targeted appointments for patients with three conditions – breast cancer, depression and rheumatoid arthritis – that are both prevalent and associated with high out-of-pocket costs.

They found 527 visits that contained conversations about health care costs; doctors and patients discussed cost-saving strategies in 45 percent of these conversations.

The most common strategy was to try to reduce costs by changing the timing, source, or location of the patient’s health care. This could mean requesting a 90-day supply of a drug rather than a 30-day supply to reduce total co-pays over the year. It could mean scheduling expensive tests at the end of the year, when patients were more likely to have already met their deductibles.

Another common strategy was to switch patients from medications with high co-pays to drugs with little or no co-pays. Doctors also suggested co-pay assistance or drug coupons when patients were starting new brand name medications.

Ubel says he was surprised by how common these conversations were – and how little time they took.

"Most of the time when they talked about health care costs, it took less than 30 to 60 seconds to cover that topic," he says. "Even with those short conversations, you saw them coming up with concrete, viable strategies to reduce out-of-pocket costs. It can be done pretty efficiently."

Ubel suggests one way to make these types of conversations even more common: The intake forms patients fill out while waiting to see their provider could include questions about whether the patient has concerns about cost or if he's having difficulty paying past medical bills.

"I would think the doctor would then realize, 'oh my gosh, they've got a problem I didn't recognize. I should see if I can help them,'" Ubel says.

These findings come as a slew of recent reports show that more insured Americans are struggling to afford their out-of-pocket health care costs. Part of the problem is that more people now have to reach a higher deductible before their insurance kicks in: In 2003, just 1 percent of Americans with private insurance had a deductible of $3,000 or more; in 2014, it was 11 percent.

The concept behind high-deductible plans is that if people have more financial "skin in the game," they'll become smarter health care consumers. But that idea hasn’t yet panned out.

A recent study found that people enrolled in high-deductible plans are no more likely than those in traditional plans to shop for affordable care. Rather, one in four Americans avoided getting needed health care because their deductible was too high, the consumer group Families USA reported last year.

KPCC's #JustAsk campaign encourages people to discuss the cost of health care with their doctors.