With the drive toward value-based healthcare delivery, doctors feel conflicted about what is expected of them. On the one hand, they want to get the best outcomes for their patients. But on the other, they feel increasingly pressured to police costs by payers, suppliers, and patients.

This tension is a barrier to the goals of value models, according to a study titled "Cost of Care and Physician Responsibility" recently released by University of Utah Health (UUH) and Catalyst, an arm of the New England Journal of Medicine focused on value in health care delivery. The study results found that much of the disconnect centers around definitions of value and the role physicians should play in new delivery models. The survey sponsor said they wanted to learn more about how physicians think about cost and patient care.

“This [survey's results] countered the narrative that physicians don't care about cost,” Robert E. Glasgow, M.D., FACS, professor and vice chairman, Clinical Operations and Quality, chief value officer, Department of Surgery at UUH told HCB News. “We found clinicians feel a great sense of responsibility around keeping costs affordable for patients. We also discovered that they don't feel they have the tools to know, the time to discuss, or the ability to impact how much things cost. And that's a problem.”

Among the survey physician findings (payers and patients were also surveyed separately) were that 86 percent of physician respondents said they are not adequately trained even to discuss the cost of care. Also, 64 percent said there is not enough time to discuss the costs of treatments with patients. Additionally, 90 percent of those surveyed believe that health care costs are too confusing for patients, while 78 percent feel the necessary tools are not available for patients to estimate health care costs.

“As the survey shows, physicians feel responsible for how much their patients have to pay for healthcare, but not accountable, because there are too many aspects of health care they cannot influence,” said Glasgow. “This disconnect can contribute to a feeling of powerlessness and dissatisfaction with the profession.”

For example, the survey found that physicians care about patient out-of-pocket costs. Five percent of respondents ranked out-of-pocket costs as important, with 32 percent rating the factor as very important and 62 percent as extremely important. Glasgow maintained that these findings dispel the narrative that doctors don’t consider the cost burden on the patient. Physicians hold the view that pharmaceutical and insurance companies are the primary drivers of rising healthcare costs.

“From a policy perspective, I think what this survey reveals is that physicians are ready to engage in the conversation. Instead of imposing financial incentives to provide value-based care, we need to broaden the value conversation to include quality and service, and invite physicians into the conversation,” said Glasgow.

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