Physician Payment Disclosure and Patients: Knowing More May Help

By: Laurie Edwards for Body1

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Know your patient rights: Information disclosure: You have the right to receive accurate and easy to understand information about your health plan, the healthcare professionals treating you and your hospital and or doctor’s office. Choice of providers and plans: You have the right to choose a healthcare provider that can provide you with appropriate healthcare. Access to emergency services: If you feel your health is in serious jeopardy, you have the right to receive emergency services whenever and wherever needed without prior authorization or financial penalty. Participation in treatment decisions: You have the right to know about all your treatment options and to participate in discussions regarding your care. You may designate someone else to represent you if you cannot make your own decisions. Respect and nondiscrimination: You have the right to receive considerate, respectful and nondiscriminatory care from your healthcare providers. Confidentiality of health information: You have the right to talk privately to your healthcare providers and to have your personal medical information kept confidential. You also have the right to review and copy your own medical record and request your physician make changes if it is not correct or complete. Complaints and appeals: You have the right to a fair, fast and objective review of any complaint you have against your doctor, your health plan, hospital or other healthcare personnel. For more information on your rights as a patient, click here.

In an age of skyrocketing healthcare costs and increasing limitations in coverage, it would seem that the divide between patients and physicians is only growing further apart. Facing shorter visits and ultimately higher bills, would disclosing physician compensation accomplish anything besides alienating patients even more?

It turns out that knowing how much their doctors make doesn’t undermine patients’ trust in their practitioners and may actually increase loyalty, according to a new study out of Harvard Medical School.

“This study suggests that regulators, policy makers and physician groups themselves should renew their consideration of disclosure as an instrument to advance the best interests of patients and physicians,” said study researcher Dr. Steven D. Pearson of Harvard Medical School.

In the past decade or so, concerns have arisen over whether payment structures that “reward cost savings” would decrease patient quality of care, the authors noted in a recent issue of the Archives of Internal Medicine.

“Commentaries by physicians, media reports, editorial cartoons and even popular movies raised alarms that these new physician payment methods were creating hazardous conflicts of interest that would keep physicians from recommending expensive, but necessary, care,” researchers wrote. “This increasing suspicion about financial incentives spawned individual and class action lawsuits, and was a prominent part of the managed care ‘backlash,’” they said.

It is common in most states for health plans to disclose whatever incentives they offer physicians to employ more strategic treatment plans that cut cost, but many physician groups do not disclose these incentive plans to their patients.

The main argument in opposition to payment disclosure is the idea that learning how much physicians profit over cost-saving treatment plans would be detrimental to patients and harm the hugely important doctor-patient relationship.

In order to test this idea, Pearson and colleagues examined the effects of disclosure among 8,000 patients who were members of two large physicians’ groups in Boston and Los Angeles. Each physician group received payment from a variety of insurers, including both capitation (payment or fee charged at an equal amount per person) as well as fee-for-service, and total physician compensation was based on a combination of salary and performance incentives.

Half of the study participants were mailed a letter by the chief medical officer of their group that detailed how physicians were compensated, while the other half did not receive such a letter. After three months, researchers followed up with both groups and surveyed their knowledge of how their physicians were compensated. They also questioned participants as to their level of trust in their primary care physician as well as their loyalty to the practice group.

Those participants who read the letter were more likely to correctly identify how their physicians were compensated. While that alone isn’t too surprising, what is interesting is that three-quarters of patients receiving the letter said the payment information didn’t affect their level of trust, and one-fourth of the patients reported that the disclosure actually increased their trust.

More than half of the participants said they did not know enough about how their doctors are compensated to discern the extent to which it affected their care, indicating a larger need to educate and inform patients.

“Further creative efforts are, therefore, needed to improve patients’ understanding of the existence, or lack, of significant financial conflicts of interest in their healthcare relationships. Disclosure is likely to fill an important role in this effort,” the study authors concluded.

Last updated: 21-Aug-06