Should a hospitalist be given more information on hospital costs?

In Today’s Hospitalist, Jeremy Graham, DO discusses implications of research he’s published about hospitalists and costs: How much is that bed on the ward? Hospitalists are clueless about patient charges.

Not surprisingly, hospitalists, like almost everyone in the hospital, have no idea what anything costs.

That’s no real shock, as Graham points out:

It’s often hard for hospitalists to know these charges, which are so opaque, distortional and sometimes secret. And we haven’t been trained to think in terms of costs and charges. I know I wasn’t.

Graham argues that hospitalists should learn more about charges and prices paid in order to help their patients.

Patients see physicians as their agent or representative, but we can’t do that job without at least some semblance of information about the costs and value of our services. It’s incumbent on us to actually provide that stewardship.

He also provides an example of how things might be done differently if hospitalists had that information.

I’m certainly seeing more self-pay patients, and their direct burden is getting nothing but bigger. Hospitalists, once they’re aware of the charges a patient would incur, might decide to do a cell count every other day instead of every day.

I’m generally in favor of transparency and efficiency, but I’m not 100 percent comfortable with the idea of hospitalists becoming somewhat more knowledgeable about what things cost. There are a couple reasons why:

  • The whole topic area is so convoluted and arcane that it would suck up all of a hospitalist’s time to learn the information and keep on top of it. I’m not even sure it’s possible, because charges do not translate at all well into what insurers (never mind patients) actually pay. I’d rather have hospitalists use their spare time to stay on top of the clinical literature.
  • I worry that hospitalists might not use the information in the right way, and in particular that they might make assumptions about patient preferences that are incorrect. In the example above, do we really want a hospitalist deciding how often to do a cell count based on perception of who’s paying and how much? I don’t.

I think it would be better to educate physicians on evidence based care including comparative effectiveness research. It could also be useful to make physicians aware of what interventions are more and less cost effective, and to provide tools to help doctors make trade-offs under different scenarios. But just providing hospitalists with more information about charges is not going to be very useful and may cause harm.

David E. Williams is co-founder of MedPharma Partners and blogs at the Health Business Blog.

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  • http://www.wjhb.de William

    Clearly the answer is yes. Yet hospital management ought to make cost information easy to access so it doesn’t waste time. If patients benefitted immediately from this they would see their doctors as fighting for them and not refusing them care. One could also argue that this is management’s responsibility.

    The USA is not the only country struggling with health care costs. In Australia they have a corruption scandal involving pharmaceuticals and hospitals that you might want to read or listen to: http://www.radioaustralia.net.au/pacbeat/stories/201104/s3200246.htm .

  • http://natickpediatrics.net Rob Lindeman

    Well done, David! Spot on as usual

  • JPB

    This is a big problem for all doctors. They simply have no clue what anything costs. Moreover, it is very difficult for anyone to find out what something will cost BEFORE the service is rendered. If we are to get our medical costs under control, prices of all services must be readily available!

  • http://roadtosuccessandservice.blogspot.com/ Emelia

    I totally agree that hospitalists should be made more aware of the costs of certain interventions. Case in point, at my hospital a doctor ordered the patient to be placed on telemetry if the unit had it, but if there was no telemetry on the unit, the doctor went on to say that the patient did not need to placed on telemetry. Now I bet if he knew the costs of that monitoring, that he may think twice about whether the patient really needed to be monitored or not and save the patient some money. Instead, the patient now has hundreds of dollars more added onto their hospital stay for something that they may not have needed. Very sad system we live in today indeed.

  • http://www.dialdoctors.com Dial Doctors

    David I agree with you that knowing costs might end up harming patients. Doctors may end up avoiding necessary tests or procedures for fear of racking up the bill specially if they know that the patient is in economic distress. Some things simply need to be done various times in order to monitor the situation. Doctors are trained to do everything needed in order to help the patient. I don’t want our doctors or even my personal one weighing costs while I need something done.

    • http://www.wjhb.de William

      Sounds like the case for a genuinely independent ombudsman (patient advocate): Double-checking is needed everywhere. Cost controls by physicians (in this case hospitalists) is just one potentially corrective control which could be built into the system. Important question: Who loses big time if hospitalists contributed to cost controls (in the context of more appropriate and proven treatments)?

  • Marc Gorayeb, MD

    So we’re not to be trusted to make sound clinical judgments knowing the cost of what we order? This is a preposterous assertion. In my view, it should be our ethical obligation to know the costs and to inform our patients what they are. Unfortunately, as you correctly point out, obtaining that knowledge is virtually impossible right now. This is precisely where health care reform needs to go. It should be our duty whenever possible to enlist our patients’ participation in making these cost-benefit analyses. After all, they are ultimately paying for the services, either directly or indirectly.

  • soloFP

    How about the cost of the patient who does not want to go home and to stay just one more day? How about the often daily lab orders on inpatients for CBC, CMPs, CXRs, etc? How about the patient who gets 8 chest CTs in 6 months of ER visits or 4 Echocardiograms across 4 months of hospital stays? The biggest thing with ordering any test is to ask the patient and yourself, what will you do with results? How will this study or test change my treatment plan? This would save a lot of time and money in medicine.

    • pj

      Absolutely correct!!!!