BOSTON — A one-page list of 56 common medical tests and procedures could shake up the way doctors deliver care at Beth Israel Deaconess Medical Center. Why? Because there’s a price next to each item.
Such lists are very unusual. Most doctors have no idea what they are spending when they order care for patients — and finding out is an eye-opening experience.
“I didn’t realize that the prices were as high as they actually were, although I knew that there were some pretty extreme examples,” said David Ives, a primary care doctor and the medical director of Affiliated Physicians Group, the largest group of private doctors that admits patients to Beth Israel.
“One [price] that really pissed me off,” Ives said, ”was that when you send someone to an ear, nose and throat [specialist], something like 80 to 90 percent of the time they get a flexible scope of their sinuses.”
Ives says using this flexible cord with chip camera is rarely better than having the doctor look up a patient’s nose or down their throat, but it costs 10 times more than the physical exam.
“It’s just done because the technology is there,” Ives continued, throwing up his hands. ”Is there value added for that? And I thought, probably not. And that might someday dissuade me from referring to someone who does a lot of those.”
Ives acknowledges that some ear, nose and throat specialists would disagree and argue that the scope is a valuable test. But raising that disagreement is part of the point of the price list. Phil Triffletti, another primary care doctor at Beth Israel, says that as health care costs continue to rise, physicians need to talk to each other about which tests or procedures are worth the money.
“Really, the increases are unsustainable,” Triffletti said. “We have a responsibility as health care providers to make sure we get the best health care we can out of the money that’s available.”
But considering costs and deciding what’s worth the money is not part of most medical school programs, says Neel Shah, who directs a website, costsofcare.org, that tries to help doctors understand how their decisions affect what patients pay for care.
“In medical school, forever, you’re taught: do no harm,” Shah explained. “If it’s safe and it has a reasonable chance of working, you do it and that’s it.”
Some doctors say considering costs as they care for patients is unethical. Shah mentioned the slogan that guides physicians at the hospital where he practices.
“The slogan at Brigham and Women’s is: ‘everything possible,’” Shah said. “So the question is: how do you re-frame cost conversations within the doctor-patient relationship. That’s a challenge because traditionally, it’s considered to be taboo.”
The taboo is lifting, Shah says, as more doctors realize that medical bills are the leading cause of personal bankruptcy; so, ordering care that isn’t clearly necessary can cause harm. The taboo may be pulled away as more and more doctors are responsible for managing patient medical budgets.
“I want doctors to think about the costs of the things they are doing,” said Richard Parker, medical director for the Beth Israel Deaconess physicians group. “It’s important to think about what something costs to understand its value.”
The price list is Parker’s idea. He says he hopes that using the list will help doctors lower health care spending while making sure patients get everything they need.
“We’re not saying don’t give patients what they need,” Parker said, his voice rising. “We’ll fight hard to get them what they need, but please don’t give them what they don’t need — we just can’t afford that anymore.”
You might be wondering where you can see the price list doctors at Beth Israel are using. You can’t — unless a doctor there shows it to you. Physicians, hospitals and most insurance companies don’t make prices they agree to in a contract public.
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