Thursday, April 8, 2010

Cost Consciousness Begins in the Office and with Patients

Parity begins at home.


Today’s blog lesson begins with mention of two April articles:

One, “The Power of No,” by economist David Leonhardt, a reliable conduit to President Obama’s health care thinking which focuses on new entitlements, long term “savings,” and new taxes to support government expansion. (1)

Two, “Cost Consciousness in Patient Care – What is Medical Education’s Responsibility,” by Molly Cooke, MD, a University of California academic, who writes on what medical educators can do to instill cost consciousness in medical students and doctors in training (2).

Cooke suggests that :

• doctors become more honest about the yields of costly choices

• doctors educate patients about the low value of high cost choices

• medical schools educate “all trainees” about broad implications of health care management and financing of delivery.

These are top-down views, from government and academe, on how to contain costs.
On the Other Side of the Spectrum.

Here, on the other side of the health care spectrum, I focus on more modest bottom-up proposals, emanating from cost conscious physicians and patients.

Here I will propose you doctors,

• make a list of costs of drugs, tests, and procedures, and hand it out to patients;

• encourage your staff and your patients to become cost sensitive by signing up for Health Savings Accounts with High Deductibles, in which patients spend more of their own up-front money but save themselves money for retirement and their employers money for providing health benefits;

• prod yourselves, your staff, and your patients to ask hospitals and doctor to whom they refer to ask , “How much does this service (test, procedure, or treatment)cost?

• consider moving into a more cash-only relationships with patients with the responsibility of collecting the fee left to patients;

• investigate office-dispensing of drugs, where-in physicians pay for their own drug inventories, thereby sensitizing you to get a sense of drugs really cost.
None of these proposals will take root overnight, but they are worth contemplating if doctors are to play a positive grassroots role in bringing down costs.


1. David Leonhardt, “ In Medicine, the Power of No,” NYT, April 6, 2010.

2. Molly Cooke, MD, "Cost Consciousness in Patient Care – What is Medical Education’s Responsibility?" NEJM, April 8, 2010

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