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The Medical Professionalism Blog

Doctor, How Much Does It Cost?

In January, I wrote about my surgical experience for a detached retina. Since then, I met Neel Shah and learned about his organization, Costs of Care.  I also read the essays of his essay contest winners. Neel wants to bring awareness of the cost of specific tests and treatments to physicians and patients alike.

During one of my last few post-surgical visits, my surgeon mentioned a 10 percent chance of having another detached retina in my other eye. A dreaded thought to have, to endure this again in any time soon. He recommended a laser procedure to “strengthen the eye.” The procedure would be done on an ambulatory basis and only takes a few minutes to complete. According to him, the risks are minimal. He mentioned some studies that show it has an effect in reducing the occurrence of a retina tear and other studies show it has no effect. I still wasn’t sure.

At my last follow-up visit, the subject came up again. I was emboldened by my discussions with Neel and decided to bring up the cost issue since the scientific evidence didn’t sway me one way or another. Our conversation went as follows:

Patient: How much does this laser surgery cost?

Doctor: Oh don’t worry. Your insurance pays for it in full.

This is a classic answer – we should conduct a study on how often this is the reply. What would be the answer if I didn’t have insurance?  I suspect it would be different.

Patient: But I want to know the cost of the procedure.

Doctor: I really don’t know.

Patient: Do you think it is less than $1,000?

Doctor: It probably ranges between $100 and $1,000 but really I don’t know. Why do you ask?

Patient: Just interested. I don’t need to decide today, right?

Doctor: No and I’ll want to see you in another 6 months. Good to see you.

I left his office and thought how right Neel was in this case. Physicians and patients are completely in the dark about costs. Most likely, the only ones that know the prices are in the finance department, and in a fee-for-service specialty clinic such as this one, they certainly don’t have an incentive to share that knowledge.

As patients are asked to pay more of the bill, will this change? I don’t think we can afford for physicians and patients not to gain awareness of cost.

2 Comments to Doctor, How Much Does It Cost?

  • Matt's Gravatar Matt
    March 19, 2012 at 9:22 am | Permalink

    An argument can be made that there are good reasons for doctors to be in the dark about cost. Not knowing the cost can allow them to more purely recommend the best treatment without unconscious bias toward “rationing.”

    This argument falls apart of course with a look at their balance sheets. Docs may not know the total costs of procedures, but they know exactly how much money they’re getting from each patient encounter. And they structure their day, and indeed their entire practice structure, around these economics.

    Counter argument that academics don’t do this? Sure they do, it’s just considered in the business office and the rank and file docs are kept in the dark about it.

    More: http://www.pulmccm.org/main

  • Dreama's Gravatar Dreama
    March 29, 2012 at 12:38 am | Permalink

    My NP had a list on her phone of what Rx cost at different pharmacies around town.

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