Doctors Begin to Notice That Health Care Is Really Expensive

| Fri Apr. 18, 2014 9:46 AM EDT

Andrew Pollack reports that some doctors are starting to notice that the health care they provide can be really, really expensive:

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care....Traditionally, guidelines have heavily influenced the practice of medicine, and the latest ones are expected to make doctors more conscious of the economic consequences of their decisions — even though there is no obligation to follow them.

....Some doctors see a potential conflict in trying to be both providers of patient care and financial overseers. “There should be forces in society who should be concerned about the budget, about how many M.R.I.s we do, but they shouldn’t be functioning simultaneously as doctors,” said Dr. Martin A. Samuels, the chairman of the neurology department at Brigham and Women’s Hospital in Boston. He said doctors risked losing the trust of patients if they told patients, “I’m not going to do what I think is best for you because I think it’s bad for the health care budget in Massachusetts.”

Generally speaking, this is overdue. Some doctors are highly sensitive to patient costs, but some aren't. I'm often surprised at how little doctors know about how much their treatment recommendations cost or how they're delivered. Even if you have the presence of mind to ask, sometimes they simply don't know their own systems well enough to find out.

That said, I'd recommend baby steps. First, plenty of doctors are already very cost conscious—but in the wrong direction, pushing lucrative, highly expensive treatments because it's good for their own bottom line. Sometimes it's because they have a part ownership in a diagnostic facility. Other times they're just gaming the system, as some high-volume ophthalmologists do by routinely prescribing Lucentis ($120 reimbursement from Medicare) vs. Avastin ($3 reimbursement from Medicare) for treatment of macular degeneration. Guidelines that rein in this kind of behavior are an obvious target.

Second, Congress could allow Medicare more discretion about how much it pays for various drugs. It's flatly crazy that taxpayers are the only people in the entire medical system who, by law, have virtually no leverage to negotiate pricing with pharmaceutical manufacturers.

Third, doctors should be more proactive about simply being aware of costs and sharing this information with patients. Some patients care more than others, depending on their incomes and quality of insurance coverage. But every doctor should have at least a basic idea of what different treatment options cost their patients, and they should have it quickly available right in the exam room. Nobody should get stuck with a huge bill—or even just a large bill—simply because they got sent to an out-of-network specialist or got prescribed a drug that turned out to be off their provider's formulary.

I suspect this is harder than I think. It could only be done by computer, and the software would have to have access to a ton of information. Doctors alone couldn't get it done. But electronic medical records are already taking over the profession, and with some help from the federal government I'll bet this kind of thing could be done. One way or another, cost transparency is the first step toward cost reduction.

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