Electronic Health Records

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Are patients responsible for lowering healthcare costs?

By Jennifer Bresnick

Everyone wants healthcare to be cheaper, more accountable, and safer for patients.  But do physicians believe themselves responsible for helping to make that happen, or are they blaming their patients?  According to a study in the most recent issue of the Journal of the American Medical Association, only 36% of doctors believe physicians have a “major responsibility” when it comes to slashing costs, with most pinning the blame not only on lawyers, hospital bigwigs, insurance companies, and pharmaceutical manufacturers, but on patients themselves.

Physicians are conscious of the need to cut inflated healthcare costs, and were eager to embrace patient engagement and accountability strategies that would increase preventative services to lower costs in the long run.  Ninety-eight percent of physicians agreed that patients are majorly or somewhat responsible for high healthcare costs, and need to help shoulder the burden of more accountable care.

“Given their roles, physicians’ perspectives on policies and strategies related to cost containment and their perceived responsibilities as stewards of health care resources in general are increasingly germane to recent pending and proposed policy reforms,” writes lead author Jon C. Tilbert, MD, MPH of the Mayo Clinic.  “Physicians expressed a high degree of enthusiasm for interventions that improve quality of care such as promoting continuity of care, expanding access to quality and safety data, promoting head-to-head trials of competing treatments, and limiting corporate influence on physician behavior.”

The 2556 physicians surveyed wanted more independence to choose the correct course of treatment, and supported changing their habits to reduce costly but ineffective treatments.  Unsurprisingly, they expressed dislike for cuts to their Medicare reimbursements, penalties for preventable hospital readmissions, and changes to the fee-for-service model of payment.  They also blamed trial lawyers for overblown malpractice suits that require expensive insurance, with a quarter of physicians admitting that their enjoyment of practicing medicine was reduced by the threat of lawsuits.

While the survey participants were generally in favor of cost-containment strategies, such as using cost-effectively data to analyze their services and being more aware of the cost of certain treatments, the majority thought that the cost of a particular treatment only matters if the patient is paying for it out of pocket.  Seventy percent thought clinical decision support tools would help them make better choices about the treatments they order, while 78% believe that they should be solely devoted to a patient’s welfare regardless of the costs involved.

“Moving toward cost-conscious care in the current environment in which physicians practice starts with strategies for which there is widespread physician support might create momentum for such efforts, including improving quality and efficiency of care and bringing transparent cost information and evidence from comparative effectiveness research into electronic health records with decision support technology,” Tilbert concludes. “More aggressive (and potentially necessary) financing changes may need to be phased in, with careful monitoring to ensure that they do not infringe on the integrity of individual clinical relationships.”




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