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Understanding the Cost of Dermatologic Care: A Survey Study
TAKE-HOME MESSAGE
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This study surveyed dermatology providers, residents, and patients to measure how well these populations understand the cost of dermatologic care and treatment and how these costs are communicated. Dermatology providers and residents consistently underestimated the true cost of common dermatologic medications. However, they accurately predicted dermatologic procedure costs. Patients preferred to know medication and procedure costs even when insurance covered them.
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Improving awareness and communication about medication and procedure costs among dermatology providers and residents may improve outcomes by establishing rapport and increasing patient adherence, thus potentially reducing healthcare expenditures.
- Jeffrey Scott, MD
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care.
OBJECTIVE
This study sought to measure dermatology providers' understanding of the cost of dermatologic care and how those costs are communicated to patients. We also aimed to understand the perspectives of patients and dermatological trainees on how cost information enters into the care they receive or provide.
METHODS
Surveys were systematically developed and distributed to 3 study populations: dermatology providers, residents, and patients.
RESULTS
Response rates were over 95% in all 3 populations. Dermatology providers and residents consistently underestimated the costs of commonly recommended dermatologic medications but accurately predicted the cost of common dermatologic procedures. Dermatology patients preferred to know the cost of procedures and medications, even when covered by insurance. In this population, the costs of dermatologic medications frequently interfered with patients' ability to properly adhere to prescribed regimens.
LIMITATIONS
The surveyed population was limited to the northwestern United States and findings may not be generalizable. Cost estimations were based on average reimbursement rates, which vary by insurer.
CONCLUSION
Improving dermatology providers' awareness and communication of the costs of dermatologic care might enhance medical decision-making, improve adherence and outcomes, and potentially reduce overall health care expenditures.
Additional Info
Disclosure statements are available on the authors' profiles:
Understanding the Cost of Dermatologic Care: A Survey Study of Dermatology Providers, Residents, and Patients
J Am Acad Dermatol 2017 Feb 08;[EPub Ahead of Print], AJ Steen, JA Mann, VM Carlberg, AB Kimball, MJ Musty, EL SimpsonFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study by Steen et al demonstrates unequivocally that the dermatologists they surveyed had little idea how much dermatologic medications cost, generally heavily underestimating the cost. I would not have done any better. The cost of medical care is hopelessly opaque.
I’m not even sure the investigators in this study had a good handle on the costs they asked the dermatologists to estimate. The investigators obtained the “true” cost using the Drugs.com Drug Price Database. Is that database an accurate reflection of the “true” cost of treatments? How could it be when every insurer might contract for drugs at different prices?
We have a big hurdle if we want to educate patients about the “true” cost of treatment, which, at least according to this study, patients say they would like to know. If we just want to educate them about the cost they will face, we can use online resources (like GoodRx.com) to get them some sense of drug prices before they get to the pharmacy.
But the bigger issue is that when you have a crazy third-party healthcare coverage system like ours, one in which consumers don’t know the price nor much care about it if someone else is paying it, all hell breaks loose. Patients have little incentive to be good stewards of healthcare resources, especially if someone else is picking up the cost of their copayment. Doctors have a duty to their patient first and society second, and are not in a good position to ration their patients’ care (and, as this study points out, we doctors don’t have the cost information we would need even if we wanted to be in charge of rationing).
For better or worse, we’ve left it to the payers to be responsible for controlling costs. But with all the effort now to stop insurers from using step edits to control costs, I fear there will be nothing standing in the way of another 10-fold, 100-fold, or even 1000-fold increase in the cost of medications. The idea that doctors and patients should make medical decisions and that insurers should pay for those decisions irrespective of the costs sounds good on the surface, but seems like lunacy to me.