Patients Who Are More Involved in Medical Decisions Pay More

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We’re supposed to be more proactive about our health, and engage in making decisions that can impact our care. But what if that decision-sharing just adds to our medical bills?

A team of researchers from the University of Chicago School of Medicine were surprised to discover just that — patients who were more involved in their medical care decisions  spent 5% more time in the hospital and tallied up hospital costs that were $865 on average more than what less involved patients spent.

According to the study authors, shared decision-making between doctors and patients is an important part of improving care, but based on their results, the greater involvement may not always be associated with lower costs.

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To assess how big a role patients preferred to play in working with their doctors, the researchers offered a survey to those admitted to the University of Chicago’s general internal medicine service between July 2003 and August 2011. By the end of the study period, 21,754 patients had answered questions about how much information they wanted about their conditions or how much they agreed with the statement, “I prefer to leave decisions about my medical care up to my doctor.” The researchers compared these responses to the patients records.

Most wanted information about their care options, but only 28.9% wanted to play a greater role in deciding what type of care they needed. The patients who did not prefer to leave decisions solely up to their doctor spent more time in the hospital and had 6% higher costs.

Given that about 35 million people are hospitalized every year in the U.S., and about 30% of patients get involved in their medical decision making, the researchers calculated that the practice could lead to $8.7 billion in additional health care costs annually.

(MORE: Bitter Pill: Why Medical Bills Are Killing Us)

What drives up those costs? Part of the added expense could come from patients who, because they are more involved in their care, may spend more time in hospitals and utilize more resources such as tests or lab facilities. With patients who ask more questions about their care and share in deciding which tests to have, doctors may also be inclined to perform or order interventions simply to appease patients or avoid malpractice litigation.

The higher costs, however, need to be balanced with the potentially higher quality care and greater satisfaction that patients generally report when they are more engaged in their own care. That’s why the researchers were concerned by the fact that their results also showed a disparity in which patients were asking to be more involved in their care. Older, less educated, and publicly insured participants were less likely to be engaged in medical decision making, and such differences could lead to disparities in the quality of care they receive, as well as their satisfaction with their health.

“We need to think harder and learn more about what it means to empower patients in multiple health care settings and how incentives facing both patients and caregivers in those settings can influence decisions,” said study author Dr. David Meltzer, an associate professor of medicine, economics and public policy at the University of Chicago in a statement.

The study is published in JAMA Internal Medicine.

7 comments
ePatientDave
ePatientDave like.author.displayName 1 Like

Here's another solid post about the study/headline disconnect, from the academic medicine community - the Informed Medical Decisions foundation. It points out that the patients studied weren't even the sort for whom Shared Decision Making is practiced:

http://informedmedicaldecisions.org/2013/06/03/misleading-headline-implies-shared-decision-making-leads-to-higher-costs-longer-hospital-stays-but-evidence-is-lacking/

Again, the published paper itself is not the issue here - it's that the headline does not summarize what the study says.

ePatientDave
ePatientDave like.author.displayName 1 Like

Please - I've read the study and the press release, and the presser's headline is significantly off base compared to what the researchers actually measured. My post about it: http://www.forbes.com/sites/epatientdave/2013/05/29/when-bad-heads-go-viral/

Please, please, assess what the article actually says - it only measures *preferences*, not what happens (causation). If at all possible issue a correction, because The press release headline itself is mistaken. I'm sure that as a journalism grad yourself (and science writer) you'll see that it doesn't match the text of the study. Thanks - this is important.

dbhoss
dbhoss like.author.displayName 1 Like

Meaningless article. The numbers are not well thought out and delivered due to vague questions and responses. If you had someone else choose your next car for you, money night be saved as you may have chosen floor mats and a CD player. I think your doctor can provide more prescriptive and accurate care when you actively participate. In fact the converse could be true in the long run, and costs escalate without patient involvement. If you take your car to the mechanic telling him it does not run well and needs to be fixed diagnostic test cost go out of control to identify the core problem.

The key statement in the article is as it has been described repeatedly in the past . "doctors may also be inclined to perform or order interventions simply to appease patients or avoid malpractice litigation." Doctors work in fear of being second guessed. Tort reform shielding doctors from excess litigation, limiting awards,etc. Will do more to put doctors in the driver's seat and help control health costs.

thewholetruth
thewholetruth like.author.displayName like.author.displayName 2 Like

Get the Drug Makers out the Profit line and Health Care improves: 

Dementia was reversed in 3 studies and because the ingredients were natural the drug makers scrapped the researcher

Researchers in Europe and S.Amerca showed that a special combination of natural ingredients was reversing dementia and Alzheimer's in even late stages. It worked..but when the drug makers found out that all the ingredients were natural and they could not profit off the diet they dropped the researchers. The diet was still online in many countries, it worked

SEE HERE http://malalzheimer.blogspot.com/2013/03/how-to-reverse-alzheimers-disease-what.html

wenchypoo
wenchypoo like.author.displayName 1 Like

If I could do the tests I want done FOR INFORMATION PURPOSES ONLY, like C-RP, A-1C, CBC, urinalysis, NMR, and DEXA scan at home, I'd do them myself.  I can't see through my skin!  To assume nothing's wrong with me until the wheels fall off is the OPPOSITE of proactive health care.  I'm trying to avoid THE NEED for a hospital, so I require annual testing...does it matter how much it costs, as long as I pay for them?

Since it IS my body, and I DO want to stay well and ahead of health problems, I'd like a little slack cut here.  Not only am I preventing the need for hospitalization, I'm also preventing the need for intervention from Big Pharma--where the REAL expense comes from, in my opinion!  With an NMR, nobody can sell me unneeded cholesterol meds, because I have PROOF I don't need them.

neurotrumpet
neurotrumpet

@wenchypoo "does it matter how much it costs, as long as I pay for them?" Unless you're paying out of pocket, then the cost of the tests do matter. Also, keep in mind that lab tests should be ordered discriminately in a clinical context lest you get swept toward the primrose path to further unnecessary and costly testing

Gooz
Gooz like.author.displayName 1 Like

For those who want to read the paper, the PMID (pubmed ID) is 23712712. This is kind of a NON-STORY that shows a tiny difference based on a survey that may or may not reflect what patients actually ended up doing. The patients were surveyed at the beginning of their admission, and may say they want to be involved (that's what everyone tells patients to do now) and end up not being involved, or they may say they don't want to be involved, but their family ends up being extremely involved. 

The difference in length of stay was tiny. The mean length of stay was 5.34 days. The patients who wanted more involvement stayed an extra ~6 hours on average (95% CI, ~1.5- ~12 hours). The mean hospitalization costs were $14,576. The patients who wanted more involvement paid on average $865 more (95% CI, $155-$1575).