Overview
A majority of people want to receive cost information from their healthcare teams, but relatively few talk about costs with their providers. Nearly one in five people are unable to get or must delay healthcare because of cost. Having clear and understandable cost information helps people make decisions and plan accordingly. The seeks to prevent unexpected charges. Your State may have additional requirements about providing cost estimates.
Patients may be embarrassed to ask about costs or worry that providers will not offer the full range of treatment options if they think cost is an issue. Practices should take the initiative of raising the topic and making sure they have resources to address concerns. Talking about costs lets people make informed healthcare decisions and budget so they have enough money to afford their healthcare.
Action
Create a culture that welcomes patients' questions and concerns about the costs of their care.
All patients should receive understandable, useful, accurate information about the expected costs of care in advance.
- Teach everyone about the importance of having cost conversations. The website provides educational and implementation resources.
- Involve the whole team in making sure all patients have an opportunity to talk about costs. For example:
- Check-in staff can say, "We encourage you to ask questions about costs so that you have all of the information you need."
- Medical assistants can ask patients after they see the clinician, "Would you like to meet with a member of our staff to talk about the costs of the treatment options you discussed?"
- Have check-out staff ask, "Have you had all your questions about costs answered?"
- Hang posters in your patients' preferred languages that promote cost conversation. The brief shows examples of posters. Possible messages include:
- Ask your provider about costs.
- Concerned about costs? Talk to us. We want to help!
- Talk to our cost counselor about what your insurance covers.
Integrate cost into discussions about testing and treatment options.
- Include cost as a normal part of the clinical conversation.
- Use available resources to find out about costs. For example, your electronic health record may tell you whether a medicine is covered by the patient’s insurance.
- If you do not know the exact costs, share relative costs (e.g., this option is typically twice as expensive).
- Acknowledge non-healthcare costs involved in treatment. Patients care not only about the money they have to spend on treatment, but also about indirect costs. They may lose income because they have to take time off work or have transportation or childcare costs. For example:
- "I know getting to visits or taking time off work can be hard. For the physical therapy option, you would need to visit the therapist two times a week. Each visit lasts about an hour, and you'd need to go for 2 months. Would that be a problem for you?"
- Help patients think about the cost-benefit tradeoffs.
- Use decision aids that can help patients clarify whether they think the benefits of an option are worth the costs.
- Ask them if paying would pose a hardship for them. For example,
- "If you had to pay [$] for this treatment, would you have to skimp on other healthcare or make sacrifices in other areas of your life?"
- "Is the cost of any of your medicines a burden for you?"
- Ask patients if they would like to learn about how to get help paying for their healthcare. For example, you could say, "Healthcare can be expensive. Would you like to talk to someone about options for getting help paying for your treatment?"
Designate someone in the practice to be a cost counselor who can provide accurate, understandable information about patients' share of cost.
- Establish a workflow that gets patients to the cost counselor.
- Ensure privacy.
- Create spaces where you can have cost conversations without being overheard.
- If the patient is a minor, talk to the responsible adult about costs out of the child’s hearing.
- Ask patients whether they want people accompanying them (e.g., a family member, friend, or caregiver) to participate in the cost conversation.
- Help patients find out about their coverage. Use . Make inquiries directly with insurers on behalf of patients when information is not available online.
- Make it easy for patients to estimate and understand costs.
- Calculate total costs for patients. For example, if there are going to be multiple episodes (e.g., a series of injections) give them the cost for the entire course of treatment.
- Print out the cost of options under discussion so patients can consider them at home.
- Add a cost calculator to your website.
- Encourage patients to alert the practice if they are not able to follow through on their treatment plan because of cost. For example, you could include instructions on when to be in touch along with contact information for the cost counselor on After Visit Summaries. Cost counselors can connect patients with their clinician if treatment plans need to be adjusted.
Refer patients with financial needs to resources.
- Help uninsured patients get insurance.
- Refer patients to your State's Marketplace, where they can apply for insurance, including Medicaid and subsidized private insurance. Use the to find your State’s Marketplace, which will have information about getting help with applications.
- Patients who may be eligible for Medicare can help with the application from the by calling their hotline at 800–333–4114. Professionals can send questions on behalf of patients to profesional@medicarerights.org.
- Learn about programs that can provide financial assistance for healthcare. Options include:
- Programs that provide assistance for specific conditions, such as the and , , and .
- Programs that help pay for medicines.
Track Your Progress
Track the proportion of staff who have been taught about importance of cost conversations.
Before implementing this tool, and 2, 6, and 12 months later, conduct a survey of staff opinions on the importance of having cost conversations. Go to the appendix for suggestions for survey questions.
Track the percentage of patients who met with the designated cost counselor and the number who were referred to financial assistance programs at 2, 6, and 12 months.
Before implementing this tool and 2, 6 and 12 months later, track the percentage of patients are late or have not paid their bills.
Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions.
Refer to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.
