Do No Financial Harm, Either

Just as physicians are responsible for doing no harm to a patient medically, they should help patients avoid financial harm as a result of health care, according to an article in JAMA.

Authors Christopher Moriates, MD, Neel T. Shah, MD, MPP, and Vineet M. Arora, MD, MPP, wrote in an online article for JAMA that just as physicians know to “first, do no harm” when it comes to medical care, in today’s “era of unsustainable health care spending,” physicians should also consider to do no financial harm to patients.

According to the authors, physicians need to consider the kind of financial strain medical care would put on the patient and the need for care.

“To avoid the legitimate concern of exacerbating inequities, a ‘universal precautions’ approach to providing fiscally responsible care can be adopted,” Moriates, Shah and Arora wrote.

The authors recommend a four-step approach:

1. Screen for financial harm

Ask if the patient is worried about paying for the medical care or medications. Making this screening routine with patients will make it easier to discuss the delicate topic of money.

2. Adopt a universal approach

Treat all patients as if they could have unaffordable medical bills. If a test won’t help, even if the insurance covers it, don’t run it and explain why.

“Although physicians may assume that hospitalizations for insured patients are automatically covered by health plans, in reality these patients may still face large co-payments,” the authors wrote. “Thus, in some instances whether hospitalization can be avoided should be discussed.”

3. Understand financial ramifications and value of recommendations

For a patient with back pain, explain how much a physical therapist would cost and give some alternatives in case the patient can’t, or doesn’t want to, pay for that extra care.

“Many studies demonstrate that physicians are unaware of the cost of routinely ordered tests, let alone the potential financial risks for patients seeking care,” Moriates, Shah and Arora wrote.

4. Optimize care plans for individual patients

If you know the patient’s insurance won’t cover something, offer cheaper options (i.e. yoga class instead of expensive physical therapy). Physicians should also think about prescribing generic or insurance-covered drugs when possible.

Although financial discussions may be difficult, these concerns are important to patients, especially as health care costs continue to rise. Furthermore, the authors point out, physicians are already used to difficult conversations, such as opiate abuse, domestic violence and end-of-life decisions.

“To provide truly patient-centered care, physicians can live up to the mantra of ‘First, do no harm’ by not only caring for their patients’ health, but also for their financial well-being,” Moriates, Shah and Arora wrote.