How to talk to your doctor—and save money

Get insights from Dr. Orly Avitzur, medical director at Consumer Reports.

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Recent Fidelity polling data1 indicated that health care costs are the biggest factor in people’s decision to retire and pose a huge threat to their financial health before and in retirement. Fidelity estimates that the average couple retiring this year will need $260,000 in savings to pay for health care expenses throughout their retirement.2

Although health care costs are still opaque to many patients and even doctors, the good news is there are ways to get a better handle on costs—by being proactive in asking questions, and making financially smart and healthy choices.

“Traditional doctor/patient relationships are being transformed by a number of health care megatrends,” says, Dr. Orly Avitzur, a practicing neurologist and medical director at Consumer Reports, where she writes the “Proactive Patient” column. “Consequently, patients must become excellent communicators, take charge of their health, and become better consumers of health care.”

Here she shares her insights with Viewpoints on how the U.S. health care system is changing and provides tips to help empower patients to take charge of their health and save money on medical expenses—all starting with knowing how to talk to your doctors and medical providers.

What can medical providers do to help patients feel less awkward when talking about their health concerns?

Dr. Avitzur: Communication is key. Over the last decade, patients have been spending less face time with doctors, so we all need to be better communicators to maximize the time we spend together.

In spite of new regulatory and administrative demands on their time, doctors can learn to more effectively communicate with patients by using technology, patient portals, and educational materials as well as participating in care teams. They may also want to utilize Nurse Practitioners (NPs) and Physician Assistants (PAs) who may have the ability to spend more quality time with patients.

How are the roles of Nurse Practitioners and Physician Assistants changing?

Dr. Avitzur: NPs and PAs are playing a bigger role in health care delivery especially within larger group practices. They are trained to see patients in a wide variety of clinical settings and specialties. They are valued members of health teams and provide greater access to quality care in a timely manner.

A new term that people should become familiar with is APP, Advanced Practice Providers. These are typically PAs and NPs who often work in large group specialty practices such as orthopedics or dermatology. Increasingly, they are seeing more patients and have become fully qualified to handle some of the services and procedures that only doctors did in years past.

Another reason for seeing an NP or PA is that there is a coming shortage of Primary Care Physicians (PCPs). With more people gaining insurance through the Affordable Care Act, there’s a greater need for PCPs, especially in rural areas.

What can patients do to improve communications and better prepare for a doctor’s appointment?

Dr. Avitzur: Here are three things to do:

  1. Succinctly write down the top problems you are experiencing. This will help your doctor focus on what to treat first. Develop short answers to these questions: What is the nature of your complaint? How long has it been going on? What makes it better or worse? What time of the day is it the worst? What patterns have your observed?
  2. Bring a complete list of all current prescription medications. Include information on dosage and how often you take them. Also detail any over the counter (OTC) medications, vitamins, or mineral supplements you take.
  3. Keep a three-ring binder with key health documents. Among them: recent test results, lab reports, surgeries, and other relevant health information. Make a duplicate copy of these files to share every time you seek treatment from a new doctor, especially one who works outside of your network. For those more tech savvy, put all relevant information on a CD-ROM or cloud storage on your mobile device and make a copy to share.

What’s the best way for patients to ask questions about the cost of treatment?

Dr. Avitzur: Cost should be part of every conversation and patients should feel empowered to bring up the subject. Doctors are not afraid to talk about cost; however in many cases, we simply do not know the cost of services. We don’t have access to insurance product rules to be able to advise patients on exact cost and projected Out-Of-Pocket (OOP) expenses. If a patient has a billing question about a recent hospitalization, contact the hospital billing offices first; then go to the hospital’s patient advocacy team, if still not resolved.

The cost question often relates to prescription drugs. For example, some 10-30% of prescriptions are abandoned at the pharmacy, primarily due to cost. As a physician, I don’t want to find out six months later that you became more ill because you did not take your medication due to cost.

What should patients know about managing the cost of prescription medications?

Dr. Avitzur: Prescription medication is often largest cost for patients to wrestle with. Each insurance plan has a drug “formulary” or list of drugs the plan covers. In addition, there are different tiers of coverage. For example, generic drugs are listed in the lowest tier and typically are the cheapest for the consumer because they have the lowest co-pays. If your doctor forgets to bring up a generic Rx alternative during your office visit, then you should. For other ways to save on prescriptions, see the graphic below.

As a practicing neurologist, you recently joined an Accountable Care Organization (ACO). What are ACOs and will they help save money while driving better health outcomes?

Dr. Avitzur: Yes, I believe so. An ACO is a group of doctors, hospitals, and other health care providers who have come together to offer “high-value care.” That means bringing higher-quality medical care to patients and lowering costs by reducing the use of unnecessary tests and treatments. An ACO gives me access to a larger team of physicians and other experts to help me manage my patients. With more access to providers, it also sets the stage for more quality time for conversations between providers and patients.

Unlike the traditional fee-for-service payment system where health care providers are compensated for each office visit, test, and procedure, an ACO is financially rewarded for keeping patients healthy and driving down the number of tests, procedures, and doctors’ visits that have no clear benefit to the patient. Further, ACOs are rewarded when their providers communicate more closely with their patients (especially those who have chronic illnesses such as high blood pressure or heart disease) and help them select the right treatments while skipping those treatments that are deemed medically unnecessary. We expect ACOs to continue to grow in popularity.

Can patients usually save money on health care services at walk-in clinics vs. emergency rooms?

Dr. Avitzur: Typically yes. Walk-in clinics are sprouting up all across the country. They are sometimes called retail clinics and are often staffed by primary care physicians, NPs and PAs. They are not meant to replace your local hospital Emergency Room or your regular wellness visits with your primary care physician. These facilities are usually located conveniently to where people live, work or shop. They are suitable for common procedures like flu shots, sports physicals, and minor injuries such as sprains and strains. For example, if you cut your finger on a sharp knife on a Saturday night, you could quickly get it sutured at a nearby clinic. These facilities generally save you money on their narrow range of services commonly offered by PCPs, but they do not offer optimal treatment for patients with multiple, chronic conditions.

Lastly, how important is staying healthy for people to save money on health care?

Dr. Avitzur: It’s vital. We all need to better invest in and take time for our health. To stay well, remember three things:

  1. Start by knowing your key numbers: blood pressure, pulse, and cholesterol.
  2. Understand your key risk factors based on your family’s medical history.
  3. Make an effort to control your weight. Know your BMI (body mass index) because it plays a role in helping you maintain a healthy lifestyle. Some total knee surgeries or hip replacements are related to being overweight. Obesity is also associated with heart disease, diabetes, and a variety of neurologic conditions. In many cases, they can be mitigated by diet and exercise. Remember, a healthy weight is a good investment in your future health.

Learn more

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Orly Avitzur, MD, MBA, FAAN is a practicing neurologist with offices in Tarrytown and Carmel, New York, and the Medical Director at Consumer Reports. Dr. Avitzur Chairs the Medical Economics and Management Committee of the American Academy of Neurology. She also writes the Proactive Patient column for Consumer Reports on Health.
1. The Fidelity Investments Decision to Retire research represents insights from a series of in-depth interviews conducted in Boston, Chicago, and San Francisco (April 2015), and from an online survey of more than 12,000 defined contribution plan participants recordkept by Fidelity, ranging in age from 55 to 80 across all industries and income levels, who felt they had some control over their decision to retire. The research was completed in August 2015 by Greenwald & Associates, Inc., an independent third-party research firm. Fidelity also worked in collaboration with the Stanford Center on Longevity on the study.
2.Estimate based on a hypothetical couple retiring in 2016, 65-years-old, with average life expectancies of 85 for a male and 87 for a female. Estimates are calculated for “average” retirees, but may be more or less depending on actual health status, area of residence, and longevity. Estimate is net of taxes. The Fidelity Retiree Health Care Costs Estimate assumes individuals do not have employer-provided retiree health care coverage, but do qualify for the federal government’s insurance program, Original Medicare. The calculation takes into account cost-sharing provisions (such as deductibles and coinsurance) associated with Medicare Part A and Part B (inpatient and outpatient medical insurance). It also considers Medicare Part D (prescription drug coverage) premiums and out-of-pocket costs, as well as certain services excluded by Original Medicare. The estimate does not include other health-related expenses, such as over-the-counter medications, most dental services and long-term care. Life expectancies based on research and analysis by Fidelity Investments Benefits Consulting group and data from the Society of Actuaries, 2014.The Fidelity Retiree Health Care Costs Estimate assumes individuals do not have employer-provided retiree health care coverage, but do qualify for the federal government’s insurance program, Medicare. The calculation takes into account cost-sharing provisions (such as deductibles and coinsurance) associated with Medicare Part A and Part B (inpatient and outpatient medical insurance). It also considers Medicare Part D (prescription drug coverage) premiums and out-of-pocket costs, as well as certain services excluded by Medicare. The estimate does not include other health-related expenses, such as over-the-counter medications, most dental services and long-term care.
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