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Home / News & IndustryManaged Care Insight and Analysis
Updated: March 16, 2010
Talking Money Is Touchy Subject; Doctors Must Take Lead, Study Finds

Physicians and patients are caught in a catch-22 when it comes to money and healthcare.

Patients want the best medical care they can get based on what their insurance will pay. Doctors want to provide the best healthcare possible but know that what is best is not always affordable. That’s the conclusion of two academic law professors who said doctors have to take the initiative.

"Doctors need to make their treatment recommendations in the context of what patients can and can’t afford, with the understanding that some patients can’t afford what they might recommend," says Mark A. Hall, an attorney and public health professor at the Wake Forest University School of Medicine.

He said patients are counting on physicians to help guide them to the best treatment decisions –medically and financially.

The situation is becoming more and more serious as employers are making their employees pick up a greater load of their healthcare premium through higher deductibles, co-pays and out-of-pocket expenses.

The thinking of Hall and co-author Carl E. Schneider, a lawyer at the University of Michigan, appeared in a recent issue of the Journal of Family Practice.

In coming to their conclusions, the two lawyers reviewed literature on relevant professional ethics. They interviewed primary care physicians who treat lower-income patients to see how the physician-patient relationship is changed by the current trend.

Hall said doctors need training on how to effectively talk with patients about money. The experienced physicians interviewed for the study suggested asking patients not about their ability to pay, but instead about the extent of their insurance coverage to avoid the embarrassment some patients feel admitting they can’t afford their doctors’ bills.

The good news for doctors is that the conversation could stave off a medical malpractice lawsuit. Hall and Schneider found that such conversations – and the treatment decisions that resulted – created negligible legal issues for doctors. "If they have an open conversation with a patient who subsequently chooses to take a cheaper route, there’s little chance of a lawsuit because the choice is ultimately for the patient, not the doctor, to make," Hall said.

Patients shouldn’t have to be afraid to talk to doctors … it’s not a new concept, he added. It was a common practice generations ago, before employer-sponsored health insurance was standard.

Addresses: Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157; (336) 716-2011, www.wfubmc.edu/school. University of Michigan Law School, 625 South State Street, Ann Arbor, MI 48109-1215; (734) 764-1358, www.law.umich.edu.


  This article was taken from:
Pay-For-Performance Reporter

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