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Do Engaged Patients Really Cost More?

Engaged Patient
Does it cost more to be an engaged patient?

Even though I’m not convinced it’s going to cost more, the LA Times recently published an article that quickly grabbed my attention because of the title, “Patients who helped with medical choices had higher bills: study“. Shared decision-making  or patients being involved in their own care  is a topic you’ve seen me post about before and it’s something I’m rather passionate about.

So, at first glance, I was expecting to see a significant increase in the final bill, as well as length of stay. Imagine my surprise when I continued to read and find out that length of stay was increased by an average of 6 hours and the final hospital bill was increased by an average of $865. Unless that cost is being passed directly on to the consumer, I don’t consider that significant at all. Have you ever looked at a hospital bill  or health insurance explanation of benefits (EOB)? They are usually several thousand dollars. $865 is negligible in comparison, if it’s being billed to the insurance company. I’d certainly stay 6 more hours and allow my insurance to be billed an extra $865 if it meant me be able to ask questions, get a better understanding of my condition and participate in the decision making. Wouldn’t you?

In order to get a better understanding of the study that was conducted, I consulted the original journal publication JAMA Internal Medicine. I was pleased to learn that nearly 76% if the study participants were African-American and had completed high school or beyond. Over 96% of the the study participants agreed that they prefer when their doctor offers them treatment choices and asks their opinion. But, 71% of those studied, prefer to leave decisions about care up to their doctor. That may seem contradictory, but not necessarily so. It solidifies the notion that patients do have preferences and want their voice to be heard, welcomed and incorporated into the final decision for their care.

The bottom line of this study concluded that shared decision-making annually contributed to 2.6 million additional hospital days for patients and $8.7 billion in added costs to insurers and private payers. However, it is well worth investing in further analysis. We need to determine if patients who participate in shared decision-making have better health outcomes. It is quite possible that the engaged patient is not re-admitted to the hospital as often as his/her disengaged counterparts. Further studies may show a direct improvement link between patient engagement, treatment compliance, health outcome, life expectancy, patient satisfaction, resource utilization and cost containment.

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