How Primary Care Physicians Integrate Price Information into Clinical Decision-Making

Area of Science:

• Health Services Research
• Medical Economics
• Health Policy

Background:

• Limited understanding exists on how primary care physicians (PCPs) utilize paid price information in routine outpatient settings.
• Paid price information refers to the actual amount insurers pay providers for services.

Purpose of the Study:

• To explore the experiences of PCPs with access to paid price information for tests and procedures over at least one year.
• To understand how PCPs integrate price data into clinical decision-making and patient communication.

Main Methods:

• A cross-sectional study design was employed.
• Semi-structured interviews were conducted with 46 PCPs within an accountable care organization.
• Qualitative analysis utilized the constant comparative method.

Main Results:

• PCPs showed greater interest in patient-specific pricing than practice-level paid prices.
• Price information facilitated patient discussions on affordable treatment alternatives when out-of-pocket concerns were raised.
• Access to price information had a minimal impact on test-ordering patterns, with PCPs avoiding price mentions for discouraging unnecessary tests.

Conclusions:

• Physician-targeted price transparency initiatives can empower PCPs to address patient affordability concerns.
• These efforts are more effective in supporting patient financial discussions than in modifying physician test-ordering behaviors.
• PCPs advocate for shared responsibility in price discussions, emphasizing the need for support from patients, practices, and health plans.