Patient-physician discussions about costs: definitions and impact on cost conversation incidence estimates

Hunter, Wynn G.; Hesson, Ashley; Davis, J. Kelly; Kirby, Christine; Williamson, Lillie D.; Barnett, Jamison A.; Ubel, Peter A.

doi:10.1186/s12913-016-1353-2

Cited by 53 publications

(63 citation statements)

References 42 publications

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“…15, 16 Some studies covered more than one theme (Supplemental Table 1). For example, the study by Kelly et al touched on both patients’ and physicians’ attitudes toward cost communication and the associated outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…15, 16 The median sample size was 133, ranging from 22 (a qualitative analysis) 21 to 677 (encounters in breast cancer clinics). 15, 16 Over half of these studies recruited participants from cancer patients currently or previously treated in academic cancer centers or their affiliated oncology clinics. 10, 13, 14, 17-20 Three studies focused on breast cancer 10, 15, 16, 22 , one on prostate cancer 19 , and others did not focus exclusively on a specific cancer.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies (seven papers) reported physician acceptance regarding cost communication 9, 12, 15-17, 21, 25 (Table 2, Supplemental Table 3). Three studies (four papers) also explored patient attitude and that information was included in the section above.…”

Section: Resultsmentioning

confidence: 99%

“…12 Two studies collected information from self-administered questionnaires 9, 12, 25 , another two from interviews, 17, 21 and one from transcribed dialogue of audio-recorded clinical encounters. 15, 16 Two studies recruited study participants by contacting members of the American Society of Clinical Oncology (ASCO) 9, 12, 25 and one included only oncologists in an academic setting. 17 While all studies included oncologists, one focused exclusively on medical oncology, 9, 12 and another also added a physician assistant to the interview pool.…”

Section: Resultsmentioning

confidence: 99%

“…The study that analyzed dialogue at encounter level reported that 22% of the visits contained cost conversations. 15, 16 Another small sample (n=11) study asked physicians the frequency of cost communication, and the reported percentage varied widely, between 5% to 66%. 21 …”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

A review of cost communication in oncology: Patient attitude, provider acceptance, and outcome assessment

Shih

Chien

2016

Cancer

109

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The American Society of Clinical Oncology released its first Guidance Statement on Cost of Cancer Care in August 2009, affirming patient-physician cost communication was a critical component of high-quality care. This forward-thinking recommendation has grown increasingly important in oncology practice today as the high costs of cancer care impose tremendous financial burden to patients, their families, and the healthcare system. In this review article, we conducted a literature search using Pubmed and Web of Science to identify articles covering three topics related to patient-physician cost communication: patient attitude, physician acceptance, and the associated outcomes. We identified fifteen papers from twelve distinct studies. While the majority of articles we reviewed on patient attitude suggested cost communication is desired by more than half of patients in the respective study cohorts, less than one-third of patients in these studies had actually discussed costs with their physicians. The literature on physician acceptance indicated that while 75% of physicians considered discussing out-of-pocket costs with patients their responsibility, less than 30% felt comfortable with such communication. When asked about whether cost communication actually took place in their practice, percentages reported by physicians varied widely, ranging from < 10% to > 60%. The data suggested that cost communication was associated with improved patient satisfaction, lower out-of-pocket expenses and a higher likelihood of medication non-adherence; none of these studies established causality. Both patients and physicians expressed a strong need for accurate, accessible, and transparent cost information.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

A review of cost communication in oncology: Patient attitude, provider acceptance, and outcome assessment

Shih

Chien

2016

Cancer

109

View full text Add to dashboard Cite

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Quality of Care and Outcomes Among Medicare Advantage vs Fee-for-Service Medicare Patients Hospitalized With Heart Failure

et al. 2020

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MA), a private insurance plan option, now covers one-third of all Medicare beneficiaries. Although patients with cardiovascular disease enrolled in MA have been reported to receive higher quality of care in the ambulatory setting than patients enrolled in fee-for-service (FFS) Medicare, it is unclear whether MA is associated with higher quality in patients hospitalized with heart failure, or alternatively, if incentives to reduce utilization under MA plans may be associated with worse care. OBJECTIVE To determine whether there are differences in quality of care received and in-hospital outcomes among patients enrolled in MA vs FFS Medicare.DESIGN, SETTING, AND PARTICIPANTS Observational, retrospective cohort study of patients hospitalized with heart failure in hospitals participating in the Get With the Guidelines-Heart Failure registry.EXPOSURES Medicare Advantage enrollment. MAIN OUTCOMES AND MEASURESIn-hospital mortality, discharge disposition, length of stay, and 4 heart failure achievement measures. RESULTSOf 262 626 patients hospitalized with heart failure, 93 549 (35.6%) were enrolled in MA and 169 077 (64.4%) in FFS Medicare. The median (interquartile range) age was 78 (70-85) years for patients enrolled in MA and 78 (69-86) years for patients enrolled in FFS Medicare. Standard mean differences in age, sex, prevalence of comorbidities, or objective measures on admission, including vital signs and laboratory values, were less than 10%. After adjustment, there were no statistically significant differences in receipt of evidence-based β-blockers when indicated; angiotensin-converting enzyme inhibitor, angiotensin II receptor blockers, or angiotensin receptor-neprilysin inhibitors at discharge; measurement of left ventricular function; and postdischarge appointments by Medicare insurance type. Patients enrolled in MA, however, had higher odds of being discharged directly home (adjusted odds ratio [AOR], 1.16; 95% CI, 1.13-1.19; P < .001) relative to patients enrolled in FFS Medicare and lower odds of being discharged within 4 days (AOR, 0.97; 95% CI, 0.93-1.00; P = .04). There was no significant difference in in-hospital mortality between patients with MA and patients with FFS Medicare (AOR, 0.98; 95% CI, 0.92-1.03; P = .42).CONCLUSIONS AND RELEVANCE Among patients hospitalized with heart failure, no observable benefit was noted in quality of care or in-hospital mortality between those enrolled in MA vs FFS Medicare, except lower use of post-acute care facilities. As MA continues to grow, it will be important to ensure that participating private plans provide an added value to the patients they cover to justify the higher administrative costs compared with traditional FFS Medicare.

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Prevalence and Nature of Financial Considerations Documented in Narrative Clinical Records in Intensive Care Units

et al. 2018

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Key PointsQuestionHow often are cost considerations documented in narrative clinical notes, and do those considerations influence treatment decisions?FindingsIn an in silico cohort study of narrative clinical notes from 46 146 index admissions to the intensive care unit at a large academic medical center, 4% had at least 1 note reflecting financial considerations during the intensive care unit stay.MeaningEven in the intensive care unit setting, financial considerations are addressed and may be associated with adjustments to treatment decisions.

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Patient-physician discussions about costs: definitions and impact on cost conversation incidence estimates

Cited by 53 publications

References 42 publications

A review of cost communication in oncology: Patient attitude, provider acceptance, and outcome assessment

A review of cost communication in oncology: Patient attitude, provider acceptance, and outcome assessment

Quality of Care and Outcomes Among Medicare Advantage vs Fee-for-Service Medicare Patients Hospitalized With Heart Failure

Prevalence and Nature of Financial Considerations Documented in Narrative Clinical Records in Intensive Care Units

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