What Should “Shopping” Look Like in Actual Practice?

Abstract

In health care, lack of transparency about the cost of health care services to patients during clinical encounters has contributed to increased costs and high out-of-pocket expenses. Federal policy has responded to the need for more transparency and spurred discussion about ethics and the clinician's role in being transparent with patients at the point of service. This article investigates and encourages state, private market, and federal policy efforts to address what health care costs patients. This article also applies the ethical framework of principlism to cases and considers what a "shoppable service" model would demand of clinicians in practice.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Necessity of Price TransparencyHealth care delivery differs from other consumer-facing services, such as dental, legal, or veterinary services, due to limited price transparency at the point of service. 1 This opacity has contributed to increased costs and associated out-of-pocket expenses and affects patients' health care decisions, as nearly 33% of Americans in 2019 reported that they or a family member delayed treatment due to cost. 2 As a significant portion of health care costs result from physician-driven patient care decisions, 3 clinicians must increasingly consider their responsibility to address cost. Providing high-value care and considering patients' financial well-being in shared decision making, especially for "shoppable services," expands the clinician's role as a steward of health care resources and as an advocate for patient-centered care. 4 In 2017, shoppable services, defined as "service[s] that can be scheduled by a healthcare consumer in advance," 5 composed an estimated 36% of medical spending and 43% of out-of-pocket spending. 6 Recent policy efforts by the Centers for Medicare and Medicaid Services (CMS) support price reporting for shoppable clinical and diagnostic services to drive innovation; to facilitate informed, price-conscious decision making; and to promote competition. 5