Few Physicians Accurately Estimate Patient Out-of-Pocket Costs

A study published in JAMA Network Open finds that very few physicians can accurately estimate patient out-of-pocket costs for medication filling.

The study surveyed 371 primary care physicians to determine if physicians can accurately estimate out-of-pocket expenses while providing the necessary expenses. Physicians were asked to estimate out-of-pocket drug cost at four points in time between January and December, using the plan’s four types of cost-sharing: deductibles, coinsurance, copays, and out-of-pocket maximums.

According to the study, only 21 percent of surveyed physicians accurately estimated out-of-pocket drug costs even when given access to necessary information such as a patient’s insurance plans and drug prices.

 “Out-of-pocket expenses have risen dramatically in the US due to a combination of increasing health care prices and increasing insurance cost-sharing requirements. As a result, one-third of US residents have trouble paying their medical bills, even when they have insurance,” wrote the authors of the JAMA study.

The study states that patients who struggle to afford medical bills may feel the need to cut their pills in half or take their medication infrequently.

According to a CDC report, approximately a quarter of Americans delay healthcare access because of high out-of-pocket expenses.

Contrary to the JAMA study’s results, most physicians participating in the research believe it is part of their obligation to have informative conservations regarding the cost of care with their patients. Physicians providing accurate prices can enable patients to make an informed decision about their health.

Compliance with price transparency has been an ongoing challenge hospital are facing.

CMS implemented price transparency rules that required US hospitals to provide transparent information about items and services. However, a compliance report by PatientRightsAdvocate.org estimated 94 percent of surveyed hospitals were found non-compliant with regulations six months after CMS implemented it.

The price transparency rule required hospitals to display information on their website regarding gross charges, payer-specific negotiated charges, discounted cash prices, and deidentified minimum and maximum negotiated amounts. The rule was intended to allow patients to gain access to pricing information and let them know the cost of their healthcare treatment or medication prior to purchasing.

As non-compliancy continues, CMS will increase penalties for hospitals under the 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Non-compliant hospitals with over 30 beds will be fined a penalty of $10 per bed. This new rule can require non-compliant hospitals to be responsible for paying a maximum of $2 million.