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J Gen Intern Med. 2017 Jan;32(1):81-87. doi: 10.1007/s11606-016-3805-0. Epub 2016 Aug 25.

How Primary Care Physicians Integrate Price Information into Clinical Decision-Making.

Author information

1
Harvard Medical School, Boston, MA, USA.
2
Department of Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
3
Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
4
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
5
National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA.
6
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
7
Partners Healthcare System, Boston, MA, USA.
8
Harvard Medical School, Boston, MA, USA. alyna.chien@childrens.harvard.edu.
9
Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA. alyna.chien@childrens.harvard.edu.

Abstract

BACKGROUND:

Little is known about how primary care physicians (PCPs) in routine outpatient practice use paid price information (i.e., the amount that insurers finally pay providers) in daily clinical practice.

OBJECTIVE:

To describe the experiences of PCPs who have had paid price information on tests and procedures for at least 1 year.

DESIGN:

Cross-sectional study using semi-structured interviews and the constant comparative method of qualitative analysis.

PARTICIPANTS:

Forty-six PCPs within an accountable care organization.

INTERVENTION:

Via the ordering screen of their electronic health record, PCPs were presented with the median paid price for commonly ordered tests and procedures (e.g., blood tests, x-rays, CTs, MRIs).

APPROACH:

We asked PCPs for (a) their "gut reaction" to having paid price information, (b) the situations in which they used price information in clinical decision-making separate from or jointly with patients, (c) their thoughts on who bore the chief responsibility for discussing price information with patients, and (d) suggestions for improving physician-targeted price information interventions.

KEY RESULTS:

Among "gut reactions" that ranged from positive to negative, all PCPs were more interested in having patient-specific price information than paid prices from the practice perspective. PCPs described that when patients' out-of-pocket spending concerns were revealed, price information helped them engage patients in conversations about how to alter treatment plans to make them more affordable. PCPs stated that having price information only slightly altered their test-ordering patterns and that they avoided mentioning prices when advising patients against unnecessary testing. Most PCPs asserted that physicians bear the chief responsibility for discussing prices with patients because of their clinical knowledge and relationships with patients. They wished for help from patients, practices, health plans, and society in order to support price transparency in healthcare.

CONCLUSIONS:

Physician-targeted price transparency efforts may provide PCPs with the information they need to respond to patients' concerns regarding out-of-pocket affordability rather than that needed to change test-ordering habits.

KEYWORDS:

health services research; primary care; technology assessment

PMID:
27561735
PMCID:
PMC5215149
DOI:
10.1007/s11606-016-3805-0
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Compliance with Ethical Standards Funders This work was financially supported by the Robert Wood Johnson Foundation Health Care Financing Organization. The sponsor had no role in the design or conduct of the study; the collection, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript or the decision to submit. Prior Presentations 2015 Society of General Internal Medicine Annual Meeting. Financial Disclosure The authors have no financial relationships relevant to this article to disclose. Conflict of Interest Dr. Thomas D. Sequist is a member of Aetna’s Racial and Ethnic Equality Committee. All other authors declare that they have no conflict of interest.

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