Cost Needs to Be Part of the Medical Informed Consent Process

To protect patients, "financial informed consent" must be integrated into the established medical informed consent process.

Almost six years after the passage of the Affordable Care Act, one in five Americans will struggle to pay medical bills. Three in five bankruptcies in the United States are due to medical bills.

Both research and anecdotal evidence show that it is common for patients to receive a "surprise bill" after emergency rooms visits and scheduled surgeries. In both cases, diligent patients select doctors and hospitals within the health insurance network only to receive a large, unexpected bill from an out-of-network provider that is often charging extremely high rates -- especially when compared to the bill from an in-network provider.

In most cases, patients entering hospitals or seeking medical services are required to sign a blanket consent form dictating that the patient pay whatever is billed before even being seen by a medical practitioner. Once seen, medical providers order diagnostic tests and procedures often without consulting the patient as to the medical reasoning for ordering the test and certainly without balancing the cost of the test or procedure against the actual likelihood of finding the underlying condition for which the test is sought. In short, patients can be charged with high fees for the medical provider to practice defensive medicine.

Certain states have provisions to protect against balance billing for patients who go to in-network providers. New York recently enacted legislation protecting patients against "surprise billing" in emergency room services.

But more needs to be done to encourage, if not require, that medical providers practice "financial informed consent" when ordering tests, recommending procedures and when utilizing out-of-network providers (about whom the patient may not be aware).

Health care is now twenty percent of the United States economy. Health care costs are now ranked as one of the greatest burdens American families experience.

Establishing a principle that the cost of medical care must be balanced as a factor in the welfare of the patient is paramount to both individual patient health as well as the health of the American economy.

The principle is simple. When customers go into stores or restaurants they are told the cost before placing the order. In health care, most providers know or should know the approximate cost of a routine procedure. Clearly, medical care can require contingencies. Few would doubt that extraordinary events may vary costs and such complicating events can cause unpredictability for which medical providers should be fairly paid. But the range of a typical procedure or test can and should be known to patients before agreeing to undertake the steps in the provider recommended medical path.

Discussion of cost is integral to quality medical care since the weight of bills taken home will impact the health of the patient (and his or her family) in both short and long run.

Patients may reasonable decide not to undergo expensive tests or procedures if either the suspected disease or ailment is very unlikely or the patient has decided he or she will not elect to undergo the array of treatment should the suspected diagnosis be confirmed. Physicians, hospitals and other providers can be protected from patient decisions not to undertake suggested medical tests by using informed consent documents (that indicate the patient was explained the importance of the test or procedure and declined the recommendation for financial or other reasons).

"Financial informed consent" demands that the cost of treatment be disclosed so patients can factor cost into decisions about medical treatment. Our health depends on it.

Elizabeth Ann Glass Geltman is an associate professor at the City University of New York (CUNY) School of Public Health and the Urban School of Public Health at Hunter College.