“Cost of Treatment May Influence Doctors” Times Two

On April 17, 2014, the New York Times bleated the alarm that “some of the most influential medical groups in the nation are recommending that doctors weight the costs, not just the effectiveness of treatments, as they make decisions about  patient care.”

This is important, but is this news?

Wasn’t it the very same New York Times that, only several days earlier on April 9, 2014, trumpeted the release of the Medicare Billing Data Set providing “an unprecedented look at the practice of medicine across the country, shedding fresh light on the treatment decisions physicians and other practitioners make every day”?

 Here we have two perspectives on the same issue. First, the April 9th article focused on health care provider reimbursement (influencing treatment decisions) and then the  April 17th article focused on society wide costs of treating without an eye to cost (now coming to influence treatment decisions).  Either way, though, “Cost of Treatment May Influence Doctors.”

The increase in treatment cost price sensitivity could be a good thing, in an era of shared decision making in the clinical encounter.   The April 9th version of physician reimbursement cost sensitivity appears to be documented by certain identifiable health care providers doing very well indeed on the Medicare prescription drug markup. This kind of price sensitivity — now revealed — might generate a useful conversation on the idea of capping or titrating the Medicare  provider-delivered prescription drug markup. Perhaps a more accurate headline would read: "Cost of Treatment/Reimbursement Rate to Providers May Have Already Influenced Doctors." Better to discuss than to feign ignorance. 

The April 17th version of health care cost sensitivity  focused on a cost-benefit analysis of a particular treatment option, and looks behind the curtain of insurance to discuss the role price-inconsiderate treatment recommendations play in health care cost inflation. This kind of cost sensitivity conversation might generate a much needed conversation about the total health care spend reaching all the way back to medical school education where there is a  growing recognition of the need to include basic training in health care costs and health insurance in the curriculum.  Some schools, after all, have already begun.

Cost has always mattered.  Reimbursement to providers has always mattered.  Is it news because the New York Times says it is or because we are ready to hear it?


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