AUDIE CORNISH, HOST:
When you go in for a doctor's visit, you don't usually talk to your physician about how much your care will cost. But there are pushes now for that conversation to happen because many people are on the hook for a larger portion of their medical bills. KPCC's Rebecca Plevin reports medical schools are evolving to meet this need.
REBECCA PLEVIN, BYLINE: Time for a pop quiz. When it comes to health care, what's the difference between cost charge and payment?
SARA-MEGUMI NAYLOR: Does anybody want to take a stab at it?
PLEVIN: Sara-Megumi Naylor is a chief resident at UCLA. She poses the question to a group of first-year residents. Naylor answers with a car metaphor.
NAYLOR: Producing the car might be 10,000, but the price on the window might be, like, 20,000. And then you might end up giving them, like, 18,000, right? So that's cost versus charge versus payment.
PLEVIN: It might seem natural for new doctors to learn about the cost of the care they're providing. But, in fact, doctors were typically taught to provide the best care possible, leaving the cost considerations aside. So, says Dr. Janis Orlowski with the Association of American Medical Colleges...
JANIS ORLOWSKI: It was not traditionally part of the medical school curriculum, but we have seen a dramatic change in the fact that now physicians are being trained to talk about cost.
PLEVIN: There are a couple reasons for this. One is the Affordable Care Act. It rewards doctors for providing high-value care, not for how many tests they order. And people now have high-deductible health plans. They have to pay a lot for their care before insurance picks up the tab. Orlowski says that's why doctors now have a responsibility to consider cost, even for something as common as antibiotics.
ORLOWSKI: Is this an antibiotic course that's going to cost $50 or is going to cost $5,000? We are recommending they take that into consideration when making their best recommendations.
PLEVIN: The University of California, Los Angeles, for example, has started weaving these themes into daily lessons. Dr. Reshma Gupta is leading that effort.
RESHMA GUPTA: In the everyday teaching they get about clinical medicine, you know, what medications to prescribe, what's the name of this diagnosis, we're going to add a layer to every discussion about the value part of that as well.
PLEVIN: She says it's important to teach students and residents how to start these conversations with older mentors. Gupta gives them a rough script.
GUPTA: I value your experience, but I also read this journal article that tells me that, you know, maybe we should be using this antibiotic instead of this one. What are your thoughts on it?
PLEVIN: But getting buy-in from students can be challenging. Dr. Paul Lyons is with the UC, Riverside medical school.
PAUL LYONS: They're so busy trying to master the basics of medicine that I think it feels like this is one more issue they're being asked to master when they have so much on their plate already.
ISAIAH ROGGOW: I'm just going to do some head-to-toe questions real quick.
PLEVIN: These lessons came alive while UC, Riverside medical student Isaiah Roggow was volunteering at a free clinic. He tried to order a $400 blood test. But he learned the clinic doesn't offer it. It's expensive and usually not that helpful.
ROGGOW: Most of the time when it's a positive test, it actually means we just have to do more tests. And does that actually serve the patient at all? Now they're just worried 'cause they have this abnormal test that stresses them out maybe for nothing.
PLEVIN: Roggow says it's becoming second-nature for students to ask whether a test is necessary given the price tag. And that means that in the future, they'll be better prepared when their patients start quizzing them about costs. For NPR News, I'm Rebecca Plevin in Los Angeles.
CORNISH: This story is part of reporting partnership of NPR, KPCC and Kaiser Health News.
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