Is it important for hospitalists to understand costs?

In Today’s Hospitalist, Jeremy Graham, DO discusses implications of research he’s published about hospitalists and costs (How much is that bed on the ward? Hospitalists are clueless about patient charges). Not surprisingly, hospitalists –like almost everyone in the hospital– have no idea what anything costs. That’s no real shock, as Graham points out:

It’s often hard for hospitalists to know these charges, which are so opaque, distortional and sometimes secret. And we haven’t been trained to think in terms of costs and charges. I know I wasn’t.

Graham argues that hospitalists should learn more about charges and prices paid in order to help their patients.

Patients see physicians as their agent or representative, but we can’t do that job without at least some semblance of information about the costs and value of our services. It’s incumbent on us to actually provide that stewardship.

He also provides an example of how things might be done differently if hospitalists had that information.

I’m certainly seeing more self-pay patients, and their direct burden is getting nothing but bigger. Hospitalists, once they’re aware of the charges a patient would incur, might decide to do a cell count every other day instead of every day.

I’m generally in favor of transparency and efficiency, but I’m not 100 percent comfortable with the idea of hospitalists becoming somewhat more knowledgeable about what things cost. There are a couple reasons why:

  • The whole topic area is so convoluted and arcane that it would suck up all of a hospitalist’s time to learn the information and keep on top of it. I’m not even sure it’s possible, because charges do not translate at all well into what insurers (never mind patients) actually pay. I’d rather have hospitalists use their spare time to stay on top of the clinical literature.
  • I worry that hospitalists might not use the information in the right way, and in particular that they might make assumptions about patient preferences that are incorrect. In the example above, do we really want a hospitalist deciding how often to do a cell count based on perception of who’s paying and how much? I don’t.

I think it would be better to educate physicians on evidence based care including comparative effectiveness research. It could also be useful to make physicians aware of what interventions are more and less cost effective, and to provide tools to help doctors make trade-offs under different scenarios. But just providing hospitalists with more information about charges is not going to be very useful and may cause harm.

December 15, 2010

2 thoughts on “Is it important for hospitalists to understand costs?”

  1. David
    You dont need to know prices if you are pragmatic and sensible about test ordering. Keep in mind, a $25 test can lead to an $800 one as quickly as a pricey study out of the gate. It is not always about cost, but operating characteristics of tests and what leads you down the slippery slope.

    For now, using Dartmouth variations as a benchmark, looking at best to worst in whatever category–do docs, hospitals, and systems doing the best job know costs or charges? Doubtful. They are working in good systems, good support, with positive peer pressure, and sensible approaches to test ordering.


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