Abstract：
Clinicians increasingly believe they should discuss costs with their patients. We aimed to learn what strategies clinicians, clinic leaders, and health systems can use to facilitate vital cost-of-care conversations.
We conducted focus groups and semi-structured interviews with outpatient clinicians at two US academic medical centers. Clinicians recalled previous cost conversations and described strategies that they, their clinic, or their health system could use to facilitate cost conversations. Independent coders recorded, transcribed, and coded focus groups and interviews.
Twenty-six clinicians participated between December 2019 and July 2020: general internists (23%), neurologists (27%), oncologists (15%), and rheumatologists (35%). Clinicians proposed the following strategies: teach clinicians to initiate cost conversations; systematically collect financial distress information; partner with patients to identify costs; provide accurate insurance coverage and/or out-of-pocket cost information via the electronic health record; develop local lists of lowest-cost pharmacies, laboratories, and subspecialists; hire financial counselors; and reduce indirect costs (e.g., parking).
Despite considerable barriers to discussing, identifying, and reducing patient costs, clinicians described a variety of strategies for improving cost communication in the clinic.
Health systems and clinic leadership can and should implement these strategies to improve the financial health of the patients they serve.
We conducted focus groups and semi-structured interviews with outpatient clinicians at two US academic medical centers. Clinicians recalled previous cost conversations and described strategies that they, their clinic, or their health system could use to facilitate cost conversations. Independent coders recorded, transcribed, and coded focus groups and interviews.
Twenty-six clinicians participated between December 2019 and July 2020: general internists (23%), neurologists (27%), oncologists (15%), and rheumatologists (35%). Clinicians proposed the following strategies: teach clinicians to initiate cost conversations; systematically collect financial distress information; partner with patients to identify costs; provide accurate insurance coverage and/or out-of-pocket cost information via the electronic health record; develop local lists of lowest-cost pharmacies, laboratories, and subspecialists; hire financial counselors; and reduce indirect costs (e.g., parking).
Despite considerable barriers to discussing, identifying, and reducing patient costs, clinicians described a variety of strategies for improving cost communication in the clinic.
Health systems and clinic leadership can and should implement these strategies to improve the financial health of the patients they serve.
摘要：
临床医生越来越认为他们应该与患者讨论费用。我们的目的是了解临床医生的策略，诊所领导,和卫生系统可以用来促进重要的护理成本对话。
我们在两个美国学术医学中心对门诊临床医生进行了焦点小组和半结构化访谈。临床医生回忆起以前的成本对话，并描述了他们的策略，他们的诊所,或者他们的卫生系统可以用来促进成本对话。独立编码员记录，转录，以及编码的焦点小组和访谈。
2019年12月至2020年7月期间有26名临床医生参加：普通内科医生（23%），神经学家（27%），肿瘤学家（15%），和风湿病学家(35%)。临床医生提出了以下策略：教临床医生发起成本对话；系统地收集财务困境信息；与患者合作以确定成本；通过电子健康记录提供准确的保险范围和/或自付费用信息；制定当地最低成本药房清单，实验室,和专家；聘请财务顾问；并降低间接成本(例如，停车)。
尽管讨论有相当大的障碍,识别,降低病人的费用，临床医生描述了多种改善临床成本沟通的策略.
卫生系统和诊所领导可以而且应该实施这些策略，以改善他们所服务的患者的财务状况。
我们在两个美国学术医学中心对门诊临床医生进行了焦点小组和半结构化访谈。临床医生回忆起以前的成本对话，并描述了他们的策略，他们的诊所,或者他们的卫生系统可以用来促进成本对话。独立编码员记录，转录，以及编码的焦点小组和访谈。
2019年12月至2020年7月期间有26名临床医生参加：普通内科医生（23%），神经学家（27%），肿瘤学家（15%），和风湿病学家(35%)。临床医生提出了以下策略：教临床医生发起成本对话；系统地收集财务困境信息；与患者合作以确定成本；通过电子健康记录提供准确的保险范围和/或自付费用信息；制定当地最低成本药房清单，实验室,和专家；聘请财务顾问；并降低间接成本(例如，停车)。
尽管讨论有相当大的障碍,识别,降低病人的费用，临床医生描述了多种改善临床成本沟通的策略.
卫生系统和诊所领导可以而且应该实施这些策略，以改善他们所服务的患者的财务状况。
