Following my March 13th piece about Our Role in Price Transparency, I received a number of responses from our members that warrant sharing with you:


1.  Times were simpler back when I started practice…many physicians were aware of costs when they started in private practice and feel that they practiced in cost effective ways and as physicians have moved toward an employment model of work, the work of pricing the work we do.  As one of our colleagues noted “Do you ask a plumber to give you a price estimate for the electrician’s job?”   We are almost completely divorced from the finances making charges obscure and hard for us to have an impact on the cost curve.

2.  We have a higher professional obligation to meet patient needs and protect valuable healthcare resources.  Many of us feel our profession is a calling and that the lack of physician leadership allows others to set the agenda.  In my experience, I have met physician leaders at many of our state’s hospitals and feel that they lend the clinician’s voice and perspective for the betterment of patient care.  In my own work with an Accountable Care Organization (ACO) I have seen impressive physician participation bringing their own and their patients’ voices to the work of creating an ACO.

3.  Higher costs as shown in the article were associated with hospital charges not individual physician charges.  While the article did focus primarily on the Master Charge list, it did talk about how when physicians become aware of certain costs, impressive savings can be attained.

4.  We live in a culture of more is better, however, when it comes to ourselves (physicians) we often choose less care at the end of life because we have a better understanding of the limitations of healthcare.  For me, this idea is a calling to increase patient engagement and understanding of what we can and cannot do.  I recognize that with time limitations changing the dialogue is difficult but I believe it is a discussion we ought to have with our patients.

5. There are incentives to do more care that are hard to overcome.  Medical-legal factors play a role in our medical decision making, high charge procedures are sometimes chosen over low cost interventions.  Working on tort reform has been a priority for the NHMS for years and we continue to do so.  As for cost benefits in clinical decision making, we must pursue the strongest evidence and stick to it even if it means stopping something that may impact our finances so that patients can get better care.


Most important, what I heard from you is that we need more physicians in leadership roles in hospitals and in our practices.  By being involved with how medicine is run as an industry, we can help to bring the transparency to the system that is so desperately needed.  In addition, more of us should engage in the political process and even run for office to help change policies to make it easier to understand costs and options.  One of our members, Tom Sherman, MD,  was elected last November as NH State Representative for Rockingham District 24 - Rye and New Castle.  He has been active on the most important health care topics our legislature is considering including two bills on transparency.  I hope more of you consider this in the future.  We could use more voices like Dr. Sherman’s in Concord!

Please email any questions or comments to or post a comment below.


I would love to start a doc-to-doc conversation - or perhaps teach one - on helping physicians start to feel comfortable, in the appropriate setting, saying, "Mrs (or Mr) So-and-so, you (or your family member) is dying." Often, I'm told, I'm the first doctor who uses the D word, despite the fact that the patient's been in the ER, the floor or the ICU, and even when it's crystal clear in MD and nurse communication, and imminent death is all over the chart. Family members hear words such as, "He's not doing well... Her status is worsening... She may die from this..." much less concretely than a straight-hearted talk about why s/he is dying (labs, vitals, coma). I think we'd see a lot less done at the end of life, if, collectively, more doctors were more comfortable gauging death. When more doctors are comfortable not doing more and more interventions, just because we can, then I think families and certainly patients, would be comfortable with this.