title: What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits.
abstract: More than 1 in 4 Americans report difficulty paying medical bills. Cost-reducing strategies discussed during outpatient physician visits remain poorly characterized.
  
  
  
  We sought to determine how often patients and physicians discuss health care costs during outpatient visits and what strategies, if any, they discussed to lower patient out-of-pocket costs.
  
  
  
  Retrospective analysis of dialogue from 1,755 outpatient visits in community-based practices nationwide from 2010 to 2014. The study population included 677 patients with breast cancer, 422 with depression, and 656 with rheumatoid arthritis visiting 56 oncologists, 36 psychiatrists, and 26 rheumatologists, respectively.
  
  
  
  Thirty percent of visits contained cost conversations (95% confidence interval [CI], 28 to 32). Forty-four percent of cost conversations involved discussion of cost-saving strategies (95% CI, 40 to 48; median duration, 68 s). We identified 4 strategies to lower costs without changing the care plan. They were, in order of overall frequency: 1) changing logistics of care, 2) facilitating co-pay assistance, 3) providing free samples, and 4) changing/adding insurance plans. We also identified 4 strategies to reduce costs by changing the care plan: 1) switching to lower-cost alternative therapy/diagnostic, 2) switching from brand name to generic, 3) changing dosage/frequency, and 4) stopping/withholding interventions. Strategies were relatively consistent across health conditions, except for switching to a lower-cost alternative (more common in breast oncology) and providing free samples (more common in depression).
  
  
  
  Focus on 3 conditions with potentially high out-of-pocket costs.
  
  
  
  Despite price opacity, physicians and patients discuss a variety of out-of-pocket cost reduction strategies during clinic visits. Almost half of cost discussions mention 1 or more cost-saving strategies, with more frequent mention of those not requiring care-plan changes.
authors.affiliation: Duke University, School of Medicine, Durham, NC, USA (WGH, CZZ, PAU)
authors.forename: Wynn G
authors.initials: WG
authors.lastname: Hunter
authors.affiliation: Duke University, School of Medicine, Durham, NC, USA (WGH, CZZ, PAU)
authors.forename: Cecilia Z
authors.initials: CZ
authors.lastname: Zhang
authors.affiliation: Michigan State University, College of Human Medicine, East Lansing, MI, USA (AH)
authors.forename: Ashley
authors.initials: A
authors.lastname: Hesson
authors.affiliation: Duke University, Fuqua School of Business, Durham, NC, USA (JKD, CK, LDW, PAU)
authors.forename: J Kelly
authors.initials: JK
authors.lastname: Davis
authors.affiliation: Duke University, Fuqua School of Business, Durham, NC, USA (JKD, CK, LDW, PAU)
authors.forename: Christine
authors.initials: C
authors.lastname: Kirby
authors.affiliation: Duke University, Fuqua School of Business, Durham, NC, USA (JKD, CK, LDW, PAU)|University of Illinois, Department of Communication, Champaign, IL, USA (LDW)
authors.forename: Lillie D
authors.initials: LD
authors.lastname: Williamson
authors.affiliation: Verilogue Incorporated, Horsham, PA, USA (JAB)
authors.forename: Jamison A
authors.initials: JA
authors.lastname: Barnett
authors.affiliation: Duke University, School of Medicine, Durham, NC, USA (WGH, CZZ, PAU)|Duke University, Fuqua School of Business, Durham, NC, USA (JKD, CK, LDW, PAU)|Duke University, Sanford School of Public Policy, Durham, NC, USA (PAU)
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration*; D017046:Cost Savings; D005382:Financing, Personal; D017048:Health Care Costs; D006801:Humans; D009819:Office Visits / Q000191:economics*; D010817:Physician-Patient Relations
keywords: cost of illness; health expenditures; medical decision-making; out-of-pocket costs; patient-physician communication