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I'm sure that we all can agree that data and information is only as useful as the training provided to the recipient. Additionally, it is important that the person also understand how to use and make decisions based on that information. However, with many newly insured patients gaining access to the health care system, numerous patients are not familiar with health terms, financial challenges, and treatment process. Also, they have not received any training on their new found healthcare coverage. The Affordable Care Act (ACA) was instrumental in providing more care to those that may need it most; however, they now face the challenge of receiving care within their insurance network, paying co-pays/deductibles, and determining which physician to see.

With more patients coming into the system for the first time, it will be physicians that are the first point of contact with these patients. Many will talk these patients through the issues for the first time. For physicians and administrators, they may be learning about the new plans alongside the patient. However, it is important the patient understand their care. With this said, I wanted to pose a question - are physicians up to the task of explaining what things cost or how to interpret insurance info? What can be done to help new patients receiving care under the ACA for the first time.

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Neel Shah
Replied at 9:10 AM, 23 Jan 2014

Great topic and question Jordan. Clinicians absolutely have an obligation to help patients navigate the complexity of the healthcare system, which includes helping them figure out how to afford care. It may be too big of a delta to expect physicians to know all of the specifics regarding the ACA or the prices within their referral market however they should at least know the resources that are available and be able to refer their patients appropriately. For example, the exchanges have "navigators" to help patients choose the best plan. Numerous websites offer price and quality transparency tools. At the very least, the clinicians should be prepared to help patients find and interpret the information that is out there.

Joe Welfeld
Replied at 10:39 AM, 23 Jan 2014

Frankly, to expect physicians to play a role in educating their patient (new or otherwise) about the ACA or their health insurance product is quite unrealistic. The problem is that while we talk about the impact on patients, there is a general disregard to the impact on providers.

The feedback I have been getting from the field seems to indicate that we are just scratching the surface of the financial risk to patients and providers. As patients seek care from their providers they are unaware of the out-of-pocket costs because the advertising/promotion/political commentary as well as the navigators are focusing on the cost of premiums and the related subsidies. This is resulting in a very uncomfortable point-of-service discussion about money (who is paying for this episode and when) not on a higher level discussion about the healthcare and reimbursement system/

Neel Shah
Replied at 11:04 AM, 23 Jan 2014

I think the financial risks to patients pre-date the ACA, though they may become more apparent as increasing numbers of Americans enroll in high deductible plans. Even pre-ACA however, medical bills were a leading cause of personal bankruptcy in the United States, mostly among an insured population.

Although point-of-care cost conversations are uncomfortable and require an extension of professional responsibility, I'm not sure it is any less reasonable to ask a physician to help patients navigate the affordability of their care than it is to ask physicians to stay up to date on new and complex medical technologies.

Elizabeth Glaser
Replied at 12:24 PM, 23 Jan 2014

There is a group based in Massachussetts called The Right Question Institute, that has worked on this issue when our state began universal care. "Lu, W.H., Deen, D., Rothstein, D., Santana, L., Gold, M.R. (2011). Activating community health center patients in developing question- formulation skills: a qualitative study. Health Education & Behavior".
I am including a link to the cited paper as well as their other relevant publications.


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Jordan Harmon
Replied at 8:40 PM, 23 Jan 2014

I do think some responsibility does fall on the physician when treating patients - it can't be up to the patient. Administrators and physicians must work together to make sure that patient care isn't compromised and to ensure that newly insured patients don't incur un-necessary costs. However, I don't think all responsibility should fall to each physician- it must be a partnership. Some of the best physician practices have already started ensuring that the team is ready for this conversation with the patient, which ensures the patient gets great care and comes back to the practice.

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