How Primary Care Physicians Integrate Price Information into Clinical Decision-Making
How Primary Care Physicians Integrate Price Information into Clinical Decision-Making
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DOI：
10.1007/s11606-016-3805-0
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发表时间：
2017-01-01
影响因子：
5.7
通讯作者：
Chien，Alyna T.
中科院分区：
文献类型：
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作者：
Schiavoni，Katherine H.;Lehmann，Lisa Soleymani;Chien，Alyna T.
背景：关于初级保健医生（pcp）在常规门诊实践中如何在日常临床实践中使用支付价格信息（即保险公司最终支付给提供者的金额），人们知之甚少。目的描述已支付检查和程序价格信息至少1年的pcp的经验。设计采用半结构化访谈和定性分析的持续比较方法进行横断面研究。参与者：一个负责任的医疗机构内的46个pcp。干预措施通过电子健康记录的订购屏幕，向pcp展示了通常订购的检查和程序（例如血液检查、x射线、ct、核磁共振）的中位数支付价格。方法我们询问了pcp (a)他们对支付价格信息的“本能反应”，(b)他们在与患者单独或共同使用价格信息进行临床决策的情况，(c)他们对谁承担与患者讨论价格信息的主要责任的想法，以及(d)对改善医生针对价格信息干预的建议。在从积极到消极的“直觉反应”中，从实践的角度来看，所有的pcp对获得患者特定的价格信息比支付价格更感兴趣。pcp描述说，当患者的自费问题被披露时，价格信息有助于他们与患者进行对话，讨论如何改变治疗计划，使他们更负担得起。pcp表示，价格信息只会轻微改变他们的测试订购模式，并且在建议患者不要进行不必要的测试时，他们会避免提及价格。大多数pcp主张，由于医生的临床知识和与患者的关系，他们对与患者讨论价格负有主要责任。他们希望得到患者、实践、健康计划和社会的帮助，以支持医疗保健价格的透明度。结论以医生为目标的价格透明努力可能会为pcp提供他们需要的信息，以回应患者对自费负担能力的担忧，而不是改变预约检查习惯所需的信息。
BackgroundLittle is known about how primary care physicians (PCPs) in routine outpatient practice use paid price information (i.e., the amount that insurers finally pay providers) in daily clinical practice.ObjectiveTo describe the experiences of PCPs who have had paid price information on tests and procedures for at least 1 year.DesignCross-sectional study using semi-structured interviews and the constant comparative method of qualitative analysis.ParticipantsForty-six PCPs within an accountable care organization.InterventionVia the ordering screen of their electronic health record, PCPs were presented with the median paid price for commonly ordered tests and procedures (e.g., blood tests, x-rays, CTs, MRIs).ApproachWe asked PCPs for (a) their “gut reaction” to having paid price information, (b) the situations in which they used price information in clinical decision-making separate from or jointly with patients, (c) their thoughts on who bore the chief responsibility for discussing price information with patients, and (d) suggestions for improving physician-targeted price information interventions.Key ResultsAmong “gut reactions” that ranged from positive to negative, all PCPs were more interested in having patient-specific price information than paid prices from the practice perspective. PCPs described that when patients’ out-of-pocket spending concerns were revealed, price information helped them engage patients in conversations about how to alter treatment plans to make them more affordable. PCPs stated that having price information only slightly altered their test-ordering patterns and that they avoided mentioning prices when advising patients against unnecessary testing. Most PCPs asserted that physicians bear the chief responsibility for discussing prices with patients because of their clinical knowledge and relationships with patients. They wished for help from patients, practices, health plans, and society in order to support price transparency in healthcare.ConclusionsPhysician-targeted price transparency efforts may provide PCPs with the information they need to respond to patients’ concerns regarding out-of-pocket affordability rather than that needed to change test-ordering habits.