ACP keynote: Physicians must engage on healthcare costs to strengthen relationships with patients

The United States spends more on healthcare, and puts greater financial burden on its patients, than anywhere else in the developed world.

That dynamic is harming the relationship between physicians and their patients, and it's up to physicians to lead the counterattack, said Elisabeth Rosenthal, MD, a healthcare reporter at the New York Times who delivered the keynote address Thursday at American College of Physicians (ACP) Internal Medicine 2014 conference in Orlando, Florida.

Rosenthal’s recent series, “Paying Till It Hurts,” highlighted the rising cost of healthcare in the United States and the increasing burden being shouldered by patients. Her coverage focused on the cost of common procedures and treatments, including child birth, colonoscopies, asthma medication, joint replacements, and stitches.

She said she has spoken to hundreds of patients who told her that initiating cost discussions with physicians often feels embarrassing and off-putting. So physicians must take the lead, she said.

“Doctors are not bringing up the issue, and patients are embarrassed to bring it up,” Rosenthal said. Physicians have to lead the way to make it something that’s not unmentionable. Physicians are the point of contact with these patients, and patients feel their relationship with physicians is being eroded.

“Most of these people really love their doctors, they just don’t love their bills. These bills are seen as coming from the doctor. You guys have the ability to push back on that and have an immediate effect,” she added.

The cost burden

Other ACP presentations sought to address rising healthcare costs as well.

The United States leads the developed world in health spending per person and patient out-of-pocket costs. At the same time, U.S. patients have the worst access to after-hours and weekend care, leading patients to seek treatment in emergency departments and other more expensive settings, said Kavita Patel, MD, MS, the Merkin Fellow for finance reform and clinician leadership; managing director for clinical transformation and delivery at the Engelberg Center for Health Care Reform with the Brookings Institution.

Bob Doherty, the ACP’s senior vice president of governmental affairs and public policy, says the country’s inability to deal with poverty is a huge driver of healthcare costs, since the poor have restricted access to healthcare and nutritious food.

“Until this country deals with poverty, that is going to continue to be a huge driver,” Doherty said. “Too often you see comments blaming the poor for their poor health.”

Next: Ongoing health reform efforts

Rosenthal said that physicians becoming more involved in these cost issues as patient advocates is key, and she noted that there has been movement in that direction. She pointed to an October 2013 article in the New England Journal of Medicine that called on physicians to start considering high out-of-pocket costs for procedures as a treatment side effect.

"If their hip is better, but they're losing their house, that’s not a good outcome," Rosenthal said.

Ongoing health reform efforts will also play a role in helping to ease rising healthcare costs.

The Affordable Care Act (ACA) is promoting new payment models, such as accountable care organizations (ACOs), designed to reduce the reliance on fee-for-service and create models that promote risk/reward sharing, said Rahul Rajkumar, MD, JD, FACP, senior advisor to the director at the Center for Medicare and Medicaid Innovation (CMMI).

Rajkumar said CMMI is testing about 20 different models, including the Pioneer ACO program, which a recent analysis found had saved $147 million in the first year of the program.

Patel said that the ACA won’t be the final word in health reform, and she expects reform to be an ongoing effort that will likely boost healthcare spending until scalable solutions are identified. 

“I’ve always personally believed is going to be the first of several we have to tackle,” Patel said. “We are going to have to spend some of this money, see a bump and an increase in costs, and then figure out what’s working.”