MD Clarity experts interview trusted medical professionals to gain insights on the current state of the healthcare industry. We share these stories in an effort to improve experiences for everyone.

Price Transparency Makes It Possible for Patients and Physicians to Work Together

Healthcare price transparency is critical for quality patient care. By understanding the upfront and long-term costs of medical treatment, patients can be better equipped to make any necessary financial arrangements.

“People avoid care or are unwilling to potentially seek treatment they might need because they’re scared about the financial unknown,” according to Dr. Steve Overman, a physician and Professor of Clinical Medicine at the University of Washington Medical School. In an often-confusing industry riddled with co-pays, deductibles, and variable prices depending on a particular care network, the true cost of care can keep a patient from being saddled with unexpected or unanticipated bills.

Do no (financial) harm

A girl stares at a bill for medical treatment wishing it had a little more price transparency.
Understanding the cost of medical treatments allows patients to make better decisions for themselves.

“Price, at its very foundation, is critical for both patient and provider,” says Dr. Overman. While cost is a major issue for patients, according to Dr. Overman, “You can’t get at cost without understanding price and volume.”

Understanding the true cost of treatments, procedures, and testing doesn’t just give patients the necessary information to make key decisions: It also prevents physicians from conducting work that can result in bad outcomes for patients, and from making expensive alternate recommendations that don’t offer significant improvements over standard treatments.

Cost can dictate care

Two chemists carry out an experiment.
Chemists typically know exactly what they’re examining or testing. Having that level of clarity in price transparency would do wonders for patients and their doctors.

Consider the example of a patient who has separate coverage for office visits and prescription drugs. While examinations may be covered by their insurance, drugs for chronic conditions like rheumatoid arthritis might not, leading to sticker shock throughout the treatment process and a patient stuck with a prescription that’s ultimately unaffordable.

The same can be said for lab testing, the cost of which might not be included in a particular patient’s insurance plan. What might seem like an essential step in the clinical process can be an expensive burden on the patient that might not have the desired outcome. For a result that’s inconclusive or otherwise unhelpful in treatment or diagnosis, it might not be worth the out-of-pocket expense.

Transparent pricing allows physicians to make decisions that place their patients’ best interest first. According to Dr. Overman, doctors left without price transparency are often “unwilling to move forward on a recommendation because you don’t know if it’s going to bankrupt the person.” If one particular test has a clearly demonstrated high cost, a physician equipped with transparent pricing can work to find alternative, less expensive options rather than simply settling for the costliest measure.

The future of transparent pricing

A doctor attends to a patient trying to understand her healthcare costs.
Figuring out how much it will cost to be treated for COVID-19 is important to many people.

“The only thing that holds promise for containing costs and moving our healthcare system towards the goals of value are Medicare Advantage-type plans,” believes Dr. Overman. “Saying we’re going to pay for population-based care over time incentivized both preventative care and bringing in social determinants of care to get the health outcomes we want as a system.” But until the deeply embedded structural components of the country’s healthcare system are disrupted, it’s imperative to find ways to make patient care more affordable.

Price transparency might not change the actual cost of patient care, but it makes it possible for patients and physicians to work together when determining necessary courses of action. When the system works to eliminate surprises, the patient’s experience becomes more straightforward and can lead to a greater sense of control. For physicians, transparent pricing can also serve as a guide to determine the best course of treatment for a patient while keeping costs firmly in mind.

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