Doctors Know Little About Consumer-Directed Plans
- By admin aapc
- In Industry News
- October 13, 2008
- Comments Off on Doctors Know Little About Consumer-Directed Plans
Physicians feel they know little about consumer-directed health plans, according to a Robert Woods Johnson Foundation study, giving coders the opportunity to help educate physicians and their patients.
The plans, meant to shift more responsibility for health care decisions to the individual patient, often come with high deductibles and include a health savings account.
But 43 percent of doctors said they have heard little, if anything, about these plans, and less than half (48 percent) feel ready to discuss medical budgeting with their patients.
The study highlights doctors’ nebulous role in counseling patients on financial matters.
“I think as these plans roll out, it’s really important to educate doctors about (them) and about some of the differences between these plans and more traditional models of insurance,” said study co-author Dr. Craig Pollack, a Robert Wood Johnson Foundation clinical scholar at the University of Pennsylvania in Philadelphia to HealthNews.
“I don’t think it’s at all clear in insurers’ minds what role they want doctors to play, and I don’t think physicians themselves are clear on what they’re comfortable with,” said Dr. Hoangmai H. Pham, a senior health researcher at the Center for Studying Health System Change in Washington, D.C.
Nor do patients know what role they want their doctors to play, she added. “It’s frankly very uncomfortable for both patients and physicians to talk about money in any clinical context.”
Peter V. Lee, executive director for national health policy at the Pacific Business Group on Health and co-chair of the Consumer-Purchaser Disclosure Project, said the study raises issues that go well beyond consumer-directed health plans.
“Patients under virtually every plan are seeing huge financial implications of their choices,” he said, “and historically doctors have felt they didn’t need to talk money.”
An estimated 5.5 million Americans are enrolled in consumer-directed health plans, according to the 2008 Employer Benefits Survey, an annual report released last month by the Kaiser Family Foundation and the Health Research & Educational Trust.
These plans have grown in recent years as employers have sought ways to shift more responsibility for medical decision-making to employees and their families. The theory is enrollees will forgo unnecessary services and shop for needed care based on price and quality.
But consumer-directed health plans are not like the managed care arrangements that have dominated the insurance landscape in recent years.
With the exception of some preventive-care services, coverage typically begins after the member satisfies a high deductible—upwards of $1,500—on average, for an individual, according to the Kaiser survey. The high-deductible plan is paired with either a health savings account or a health reimbursement arrangement, and funds in these accounts can be used to pay for routine medical expenses.
To assess physicians’ readiness to engage patients on cost and quality issues in these plans, Pollack and colleagues conducted a random, national survey of 1,500 primary-care physicians and received 528 responses.
About one-third of the doctors surveyed had little knowledge about how money is contributed (35 percent) and spent (31 percent) from the plans’ medical savings accounts.
Being exposed to these plans did not always mean that doctors were in the know.
“We were surprised that about a quarter of physicians who currently knew that they cared for patients in consumer-directed health plans said they really didn’t have a lot of knowledge about the cost-sharing involved in these plans,” Pollack said.
While most felt ready to discuss the cost of office visits, medications and laboratory tests, half or fewer were prepared to advise patients about the cost of radiologic studies, specialist consultations, and hospitalizations.
People enrolled in consumer-directed health plans are encouraged to take advantage of online tools to compare costs and evaluate quality when making medical decisions. But, according to the survey, physicians are deeply skeptical about the information provided by government and insurance Web sites.
Only 8 percent believed that patients could trust the information provided on insurers’ Web sites.
“If there’s going to be a lot of pushback on the part of the doctors, I think it could lead to consternation on the part of the patients,” Pollack said.
This story is an adaptation from the original HealthDay report.
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I completely agree with the article. I have been a Pharmacy Technician for 11 years. I have taken it upon myself (at the pharmacy where I work) to be an advocate for the elderly. In the past recent years the elderly are now purchasing Medicare Part D prescription coverage.
I often think of my grandparents, parents, auties, uncles, & my neighbors around me. I am fortunate to have the knowledge (and continually learning) when it comes to insurance verbage. However, the folks that I mentioned above do not.
Think of your own family members and friends. What would you tell your auntie when you just got back from the pharmacy and the medications weren’t covered. Of course auntie is going to ask you, “Why not? Do you know how much I pay a month for that insurance?”. “Well, the lady behind the counter said you’re in the doughnut-hole.” Pause for a moment-think about it. Try and explain Doughnut-Hole!!!!!!(What if auntie has dementia, hearing loss, diabetes, or high blood pressure?) I could list a thousand more conditions.
At this time in life, everything our elders do on a daily basis takes longer and might be harder for them to do. Why in Heaven’s Name, do We, as a society, intenionally make it so difficult for our elders? Isn’t this the stage of life when healthcare is accessed and needed the most? This in my book is a form of abuse.
It should be mandated that when an elder gets Medicare D-Rx coverage, a real-life human being explain in very simple language what benefits they are getting. If they have a Doughnut-Hole, explain to them what this means.
It might even be an exceptional idea to have their doctor and pharmacist review their medications. Medications could be changed to alternative or generic medications to keep costs down without giving the patient sub-standard care. It might help that patient from reaching the cap on their benefits only 4 months into the year.
I think enough has been said. You get the point. What happened to compassion and treating our Elders with respect?
Aloha from the Beautiful Garden Island of Kauai, Hawaii
Shannon Patrick
This issue reiterates the importance of relying on compitent office staff to be the financial liaison between the patient and the doctor. Having a well trained staff member who can explain medical charges and financial responsibility to the patient can help to ensure that patients are prepared to pay for their medical care up front and it takes the doctor out of the equation.
What I don’t like about these new plans is that if a patient, after finding out how much he/she will owe out of pocket, decides they can’t afford the services and declines treatment, what happens next? Is the doctor still liable for that patient’s welfare? In the past, if a patient refused treatment the physician would write him/her off as non-complaint and would dismiss the patient from his/her care, but now what? Is that course of action still appropriate?
Doctors deserve to get paid for services they provide and now that patients have greater and greater financial obligations doctors have to risk breaking most state’s laws and losing their licenses if they refuse to treat an established patient who owes them money.
Bottom line, the amount of money a patient owes is between the patient, his/her employer, and the insurance company. The doctor is going to do what is in the patient’s best interest medically and having well trained administrative support ensures that the doctor is focusing on practicing medicine and not worrying about the patient’s financial issues.