Money talks: How to broach out-of-pocket costs with patients

Physicians should take the pulse on a patient’s financial health as well as medical needs when making care decisions, two physicians proposed in a viewpoint published online April 21 in JAMA. They offered tips to make the process easier.

“In our view, physicians have an ethical duty, at a minimum, to discuss out-of-pocket costs with patients in the same way that they would discuss the adverse effects of a treatment,” wrote Kevin R. Riggs, MD, of Johns Hopkins University School of Medicine in Baltimore, and Peter A. Ubel, MD, of Duke University School of Medicine in Durham, N.C. “But when physicians actually begin to consider out-of-pocket costs as part of clinical decision making, the challenges can seem overwhelming.”

In this era of rising healthcare costs, the onus is on the physician to engage a patient in a conversation about personal costs unless the patient takes the initiative, according to the authors. He or she can break the ice by asking if the patient anticipates any problems paying medical bills. Ask about insurance status, co-payments and deductibles.

Even when a patient can afford a treatment, he or she may not find it of value. The physician may agree in cases where a service or therapy offers marginal benefit but challenge situations where a patient’s desire to minimize cost could compromise health and incur much higher downstream costs.    

Even without knowing specific prices, a physician may be able to present options. Most physicians have a general idea about what is the more expensive option, Riggs and Ubel claim, citing as examples name brand vs. generic drugs or an imaging exam vs. waiting in a situation that may resolve itself over time.

While pricing information is not uniformly transparent, physicians should try to educate themselves and their patients. Websites such as and may be useful. Price information can be integrated into computerized physician order entry systems, but they acknowledged that can be resource intensive.

Social workers and case managers also can be allies in helping patients understand their out-of-pocket costs.