Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
University of Michigan School of Medicine, Ann Arbor, MI, USA; Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA.
Patient Educ Couns. 2022 Aug;105(8):2708-2714. doi: 10.1016/j.pec.2022.04.005. Epub 2022 Apr 9.
Clinicians increasingly believe they should discuss costs with their patients. We aimed to learn what strategies clinicians, clinic leaders, and health systems can use to facilitate vital cost-of-care conversations.
We conducted focus groups and semi-structured interviews with outpatient clinicians at two US academic medical centers. Clinicians recalled previous cost conversations and described strategies that they, their clinic, or their health system could use to facilitate cost conversations. Independent coders recorded, transcribed, and coded focus groups and interviews.
Twenty-six clinicians participated between December 2019 and July 2020: general internists (23%), neurologists (27%), oncologists (15%), and rheumatologists (35%). Clinicians proposed the following strategies: teach clinicians to initiate cost conversations; systematically collect financial distress information; partner with patients to identify costs; provide accurate insurance coverage and/or out-of-pocket cost information via the electronic health record; develop local lists of lowest-cost pharmacies, laboratories, and subspecialists; hire financial counselors; and reduce indirect costs (e.g., parking).
Despite considerable barriers to discussing, identifying, and reducing patient costs, clinicians described a variety of strategies for improving cost communication in the clinic.
Health systems and clinic leadership can and should implement these strategies to improve the financial health of the patients they serve.
临床医生越来越认为他们应该与患者讨论费用问题。我们旨在了解临床医生、诊所领导和医疗系统可以使用哪些策略来促进重要的医疗费用对话。
我们在美国的两家学术医疗中心对门诊临床医生进行了焦点小组和半结构化访谈。临床医生回忆了之前的费用对话，并描述了他们、他们的诊所或他们的医疗系统可以用来促进费用对话的策略。独立的编码员记录、转录和编码了焦点小组和访谈。
2019 年 12 月至 2020 年 7 月期间，共有 26 名临床医生参与：普通内科医生（23%）、神经科医生（27%）、肿瘤科医生（15%）和风湿病医生（35%）。临床医生提出了以下策略：教授临床医生如何发起费用对话；系统地收集财务困境信息；与患者合作确定费用；通过电子健康记录提供准确的保险覆盖范围和/或自付费用信息；开发当地最便宜的药店、实验室和亚专科医生名单；聘请财务顾问；并降低间接成本（如停车费）。
尽管在讨论、识别和降低患者费用方面存在相当大的障碍，但临床医生描述了在诊所中改善成本沟通的各种策略。
医疗系统和诊所领导可以而且应该实施这些策略，以改善他们所服务的患者的财务健康状况。
