How Patients’ Out-of-Pocket Costs Impact Medical Care… and Liability

One of the most notable financial trends in healthcare is the popularity of high deductible insurance plans. Many choose these plans out of necessity: they need premiums they can afford. However, for many people, high deductible plans are too short-sighted, resulting in higher costs “out-of-pocket.” This means (and the research has proven) that patients will skip out on everyday expenses like prescriptions and doctor visits both for illnesses and preventive care.

As a result, patient health can deteriorate, and in some cases serious or terminal conditions develop, placing the physician in a very difficult position. Physicians cannot force patients to obtain appropriate or recommended preventative care. While there is no question that patients in New York State have the right to refuse treatment, it is not as clear what the physician’s rights and obligations are when a patient is consistently noncompliant. It is likely that a physician’s risk of liability is increased when a patient chooses not to seek care primarily due to cost.

Although the Association of American Medical Colleges (AAMC) says 129 out of 140 medical schools now teach students about the costs of healthcare and how to talk about it with patients, most physicians practicing today received little if any training in this area. Our Fall 2015 Dateline, which features the topic beginning on page 1, contains the following recommendations:

• Someone in the practice – whether it’s the physician or another staff member – must learn how to discuss financial matters related to medical costs and co-payments for tests and appointments.

• Physicians and staffs should become aware of, and educate patients concerning, available programs and agencies that might assist them with certain costs.

• Practices should follow up with noncompliant patients, document their attempts to encourage care and utilize a system that notifies them when a patient fails to undergo a test or see a specialist as recommended.

• Physicians should inform patients about the risks of refusing care.

• Physicians may have to consider discharging the patient from the practice if noncompliance persists.

We encourage you to read the original article for more detailed recommendations.