Why dentists should prioritize cost conversations with patients

With the cost of medical and dental care rising, it is becoming increasingly important for healthcare providers to prioritize cost conversations. To best guide these conversations, researchers examined key factors in a study published recently in the Journal of the American Dental Association.

Patients are choosing not to receive oral healthcare as the cost of all healthcare services rise. Oral healthcare is the first in all healthcare services for cost avoidance among patients, and in 2015, more than 10% of the U.S. population across all income levels avoided or delayed oral healthcare due to cost, according to the study.

As costs rapidly rise, many patients are left with a considerable financial burden after covering their care. This trend calls for an "increased consideration and sensitivity to patients' cost concerns from medical and oral healthcare providers," wrote the authors, led by Tawanna Brown of Georgia Southern University in Statesboro, GA (JADA, May 16, 2022).

The concept of cost conversations is being explored increasingly in healthcare, particularly in high-cost medical specialties like oncology. There is little research evaluating the frequency of cost conversations in dentistry despite the cost-related barriers to dental care. However, guidelines for effective cost conversations remain the same in all clinical settings.

By prioritizing cost conversations with their patients, providers can identify the sources and magnitude of financial stress for patients. In partnership with patients, they can also tailor the care plan in a way that minimizes the financial burden of care.

The study authors suggest making cost conversations "routine and for all patients, providing patients with resources to understand their health care costs and address cost concerns, and tailoring treatment plans in a manner that is responsive to patients' cost concerns." In doing so, patient satisfaction and adherence to treatment may increase.

What factors impact cost conversations?

Previous research has shown that patients prefer having cost conversations with physicians, as these conversations demonstrate that providers have the patients' best interests at heart. Despite the significance of these conversations, they rarely happen. This shortcoming can likely be attributed to the discomfort associated with talking about finances, fear of damaging relationships, lack of time, and unclear provider-patient boundaries.

To the best of the study authors' knowledge, there had been no previous research conducted to determine whether and how cost conversations are happening within dentistry. The researchers sought to examine the factors associated with the occurrence of these conversations between patients and dental providers.

Data was collected from an online self-administered survey of 370 participants. All participants had seen a dentist within the prior 24 months. Patient and provider characteristics associated with the frequency of cost conversations were identified.

Of the 370 participants, about two-thirds (68%) reported having a cost conversation with their provider during their last dental visit. These conversations happened more frequently among patients ages 25 to 44 and 55 to 64 years old than patients ages 18 to 24 years old.

Further, cost conversations were less likely to occur in visits with a dental hygienist compared to visits with a general or family dentist. Lastly, those from the South and those screened for financial hardship were more likely to have these conversations with their provider.

The most significant factor associated with the occurrence of cost conversations was found to be screening for financial hardship. This association suggests that modifications should be made to oral healthcare delivery processes to incorporate regular financial hardship screenings.

Researchers suggest this may be an effective way to facilitate cost conversations, as hardship screenings have been proven as an effective way to increase the frequency of patient-provider cost communication. Given that those experiencing financial hardship may be hesitant to have cost conversations, incorporating this regular screening can be useful in approaching conversations and ensuring that oral healthcare is patient-centered and cost-responsive for all patients.

"Modifying oral health care delivery processes to incorporate financial hardship screening may be an effective way to facilitate cost conversations and provision of patient-centered care," Brown and colleagues concluded.