Thursday, March 16, 2017

Doctors, MDD Patients Found to Have Different Cost Concerns

Health care costs appear to be a regular topic of conversation between psychiatrists and patients receiving care for major depressive disorder (MDD), occurring in more than one in three visits, according to a study published today in Psychiatric Services in Advance. The study found psychiatrists may be more likely to initiate a conversation about the cost of psychotropic medications, while patients may be more likely to initiate a dialogue about the cost of provider visits.

Gregory Brown, M.D., of Duke University School of Medicine and colleagues relied on content of patient visits sampled from the Verilogue Point-of-Practice database of audio-recorded and transcribed clinical encounters. The researchers focused specifically on visits for medication management in outpatient, private-practice offices across the United States. The researchers considered any mention of a patient’s out-of-pocket expenses or insurance coverage for a past, present, or potential health care service to be a “cost conversation.”

A total of 422 patients with MDD and 36 psychiatrists in clinics across 20 states were included in the study. The researchers found that 38% of visits contained a cost conversation. Cost conversations most commonly addressed medications (n=136 of 208; 65% of all cost conversation topics), and more than half of these conversations dealt specifically with the cost of psychotropic drugs (n=107 of 208; 51%). Nonpharmacologic therapies and services accounted for 35% of cost-conversation topics.

Although rates for initiating cost conversations were similar between psychiatrists and patients, physicians were more likely to initiate conversations about the cost of psychotropic medications than patients (62% versus 38%). In contrast, patients were more likely to initiate conversations about the cost of provider visits (27% versus 10%).

Overall, 45% of cost conversations involved at least one cost-reduction strategy, such as facilitating the use of copay-assistance programs or cost-saving coupons, providing free samples, or switching to a lower-cost therapy or diagnostic test.

“By exploring the frequency and duration of discussions about health care cost in these encounters, as well as the cost-reducing strategies therein, we are able to provide novel insights about the extent to which psychiatrists and patients discuss efforts to manage out-of-pocket health care costs,” wrote Brown and colleagues. “[W]e hope to help psychiatrists recognize the many ways in which they can help patients reduce out-of-pocket expenses.”

For related information, see the Psychiatric News article “Levin Meets With Congressional Leaders About Fate of Affordable Care Act.”

(Image: iStock/sturti)

Donate to APA Foundation Through AmazonSmile
Today ONLY! Amazon will donate 5% of your eligible AmazonSmile purchase to American Psychiatric Association Foundation. This is 10 times the standard AmazonSmile donation rate. To learn more, please visit


The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.