One Pill for Healthcare: Require that RBAs Include Presentation of Costs
Clinicians are very familiar with the acronym “RBA”: risks, benefits and alternatives. The professional and legal standard is that RBAs be presented and discussed openly and honestly between physicians and patients before treatment. The reason is to put the patient in a position of making an informed decision. With rapidly escalating out-of-pocket cost impact on consumers, we cannot accept that costs are left out of the RBA discussion. Unfortunately, physicians who present RBAs typically don’t have a clue about costs and are therefore typically in no position to help their patients consider all the relative impacts of each alternative, including the option of doing nothing. The fact is that RBA disclosures are typically devoid of any financial consideration. As a result, patients are seldom given all the information necessary to make thoroughly informed decisions about their care.
This brings to mind stories about people who are put through life extending treatments that provide a little more time but at a cost of financial devastation: “Had we only known…” We must do a better job of arming physicians with cost/benefit information so they can help their patients make the right decision. The costs shouldn’t be a mystery to anyone, but especially the patient.
Should we not work toward requiring that RBAs include a discussion about the costs of the alternatives? The economic forces in U.S. healthcare are highly unique for many reasons, not the least of which is how the consumer has been so buffered from the actual cost of care. The patient’s primary advisor, the physician, knows little about financial impacts and the true costs of care. That’s because costs are nearly impossible for anyone to comprehend, given the wide variety in health plans, unpredictable and highly variable costs, negotiated rates, and strong forces that increase physician preference for certain procedures in certain markets. As costs and their impact on the consumer skyrocket, we have to redefine the standards related to what must be disclosed to the patient. And we must arm our physicians with the information they should be required to share.
Today, providing care that leads to financial devastation with limited or questionable benefit can still be well within the standard of care. In the name of “patient centered care”, shouldn’t we ensure that patients are fully informed about the financial risks and benefits of each treatment alternative? Our healthcare system will be in a much better place when it becomes the standard of care to ensure patients are fully informed of each option.