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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 1/2017

01-01-2017 | Original Research

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

Authors: Katherine H. Schiavoni, MD, MPP, Lisa Soleymani Lehmann, MD, PhD, Wendy Guan, BA, Meredith Rosenthal, PhD, Thomas D. Sequist, MD, MPH, Alyna T. Chien, MD, MS

Published in: Journal of General Internal Medicine | Issue 1/2017

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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.
Appendix
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Metadata
Title
How Primary Care Physicians Integrate Price Information into Clinical Decision-Making
Authors
Katherine H. Schiavoni, MD, MPP
Lisa Soleymani Lehmann, MD, PhD
Wendy Guan, BA
Meredith Rosenthal, PhD
Thomas D. Sequist, MD, MPH
Alyna T. Chien, MD, MS
Publication date
01-01-2017
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 1/2017
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-016-3805-0

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