Kimberley S. Fox, MPA; Carolyn E. Gray, MPH; Martha Elbaum Williamson, MPA; Jennifer A. MacKenzie, BA
Disclaimer: The views expressed in this article do not necessarily reflect the views of the Robert Wood Johnson Foundation.
Financial Support: By the Robert Wood Johnson Foundation (grant 74125).
Disclosures: None. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2223.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Corresponding Author: Kimberley S. Fox, MPA, Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine, P.O. Box 9300, Portland, ME 04104-9300; e-mail, email@example.com.
Current Author Addresses: Ms. Fox, Ms. Gray, Ms. Elbaum Williamson, and Ms. MacKenzie: Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine, PO Box 9300, Portland, ME 04104-9300.
Author Contributions: Conception and design: K.S. Fox, C.E. Gray, J.A. MacKenzie.
Analysis and interpretation of the data: K.S. Fox, C.E. Gray, M. Elbaum Williamson.
Drafting of the article: K.S. Fox, C.E. Gray, M. Elbaum Williamson, J.A. MacKenzie.
Critical revision of the article for important intellectual content: K.S. Fox, C.E. Gray.
Final approval of the article: K.S. Fox, C.E. Gray.
Statistical expertise: C.E. Gray.
Obtaining of funding: K.S. Fox, C.E. Gray.
Administrative, technical, or logistic support: C.E. Gray, J.A. MacKenzie.
Collection and assembly of data: K.S. Fox, C.E. Gray, M. Elbaum Williamson, J.A. MacKenzie.
Patients desire information about health care costs because they are increasingly responsible for these costs. Public Web sites that offer cost information could inform provider–patient discussions of costs at the point of care.
To evaluate tools to facilitate the use of publicly available cost information during clinical visits for low back pain (LBP).
Qualitative study using individual and group interviews and surveys.
6 rural primary care practices in 2 health systems in Maine.
Practice staff (n = 50) and adult patients with LBP (n = 72).
Participating health systems and practices were offered financial incentives, a series of trainings, and technical assistance to pilot tools for discussing costs of LBP care using CompareMaine.org, Maine's cost and quality transparency Web site.
Integration of tools into workflow, awareness and value to providers, and patient experience were identified through 11 group interviews with practice staff (n = 25) and health system leaders (n = 11), provider (n = 25), and patient (n = 47) surveys; patient interviews (n = 5); and administrative data.
The intervention increased provider and consumer awareness of CompareMaine.org, but minimally changed use in clinical discussions as a result of fewer-than-expected patients with LBP, limited system support, workflow barriers, and providers' reluctance to adopt the tools because of perceptions of limited value for their patients. In contrast, patients valued cost conversations and found the tools useful, and over one half reported intending to use CompareMaine.org during future care decisions.
Generalizability was limited by the small number of practices and participants. Lower-than-anticipated participation precluded examination of the effect of the tool on the frequency of cost-of-care conversations.
This multicomponent intervention to introduce publicly reported cost information into LBP clinical discussions had low provider uptake. Whereas cost conversations and CompareMaine.org were perceived as useful by participating patients with LBP, providers were uncomfortable discussing cost variation at the point of care. Successful use of public cost information during clinical visits will require normalizing use to a broader group of patients and greater provider outreach and health system engagement.
Robert Wood Johnson Foundation.
Table 1. Practice Characteristics and Intervention Participation
Table 2. Low Back Pain–Related Procedures Searched on CompareMaine.org
Table 3. Practice, Health System, and Patient Interview Key Themes and Example Quotes
Table 4. Provider Survey
Table 5. Patient Survey
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Fox KS, Gray CE, Williamson ME, et al. Using Public Cost Information During Low Back Pain Visits: A Qualitative Study. Ann Intern Med. 2019;170:S93–S102. doi: https://doi.org/10.7326/M18-2223
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Published: Ann Intern Med. 2019;170(9_Supplement):S93-S102.
Back Pain, Rheumatology.
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