Should Doctors Consider Cost When Prescribing Treatment?

May 15, 2014
Paul M. da Costa

The New York Times reports that some medical groups are pushing for doctors to consider not just the effectiveness of treatment, but also the cost of it when making patient care decisions. This would involve doctors influencing the way health care dollars are spent, rather than focusing solely on individual patients.

According to the article, new guidelines are being developed by some medical groups for doctors. This means that doctors could choose one treatment over another because it is more cost effective, or decide that a course of treatment is too expensive, for example, at the end of life. There is no obligation to follow these guidelines, however guidelines have been proven to heavily influence medical decisions. Additionally, insurance companies use the guidelines when determining reimbursement policies. Therefore, these new guidelines will likely have a far-reaching effect on all areas of the medical community.

            Two specific areas where medical groups are developing new guidelines that include cost of treatment are oncology and cardiology. The society of oncologists is creating a scorecard, expected to be finished by this fall, that evaluates treatment based on cost, value, efficacy, and side effects. The American College of Cardiology and the American Heart Association stated that they will start using cost data when rating treatment value in their guidelines and performance standards. They will rate treatment value using the cost per quality-adjusted life-year (QALY) method. Then, treatments costing less than $50,000 a QALY would have a high value rating, and those costing more than $150,000 a QALY would have a low value rating.

Some doctors are concerned that there could be a potential conflict in having the responsibility to provide medical care to patients while considering cost effectiveness. Brigham and Women’s Hospital neurology department chairman acknowledges that someone should be concerned about medical costs and budget, but that they should not be the ones who are also providing the patient care. Additionally, the director of the center for liver disease at the University of Chicago believes that ethically, the doctor should only concern him or herself with the patient, rather than a treatment’s cost to the medical industry. Further, some people opposed to considering cost when making treatment decisions assert that it will result in a form of medical treatment rationing.

Proponents of the guidelines suggest that doctors already consider cost when making treatment decisions, and instituting guidelines will make it easier for doctors to make decisions rather than to have to engage in “bedside rationing” when treating an individual patient.

Despite criticism, it appears that this is not the first time it has been suggested to include cost when making health care decisions. According to the article, 17 of 30 of the largest physician specialty societies include cost in their clinical guidelines. Additionally, many medical societies have contributed to a campaign called Choosing Wisely by submitting lists of “five things physicians and patients should question” because they are wasteful.

We will continue to update you on the progress of the guidelines and the debate surrounding the issue of whether doctors should consider cost when making treatment decisions. Check our blog regularly so that you do not miss any of our updates.

Sarno da Costa D’Aniello Maceri LLC has a team of talented attorneys who focus their career on medical malpractice. If you have questions or concerns about any of the treatment you have received, please contact us at 973-274-5200.