Using Public Cost Information During Low Back Pain Visits: A Qualitative Study.

Document Type


Publication Date



Cutler, Population Health and Health Policy, PHHP, health care costs, health services, qualitative, health systems, patients, providers

Publication Title

Annals of internal medicine


Background: 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.

Objective: To evaluate tools to facilitate the use of publicly available cost information during clinical visits for low back pain (LBP).

Design: Qualitative study using individual and group interviews and surveys.

Setting: 6 rural primary care practices in 2 health systems in Maine.

Participants: Practice staff (n = 50) and adult patients with LBP (n = 72).

Intervention: 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.

Measurements: 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.

Results: 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.

Limitations: 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.

Conclusion: 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.

Primary Funding Source: Robert Wood Johnson Foundation.

Funding Organization

Robert Wood Johnson Foundation