Dr. Neel Shah

Talking about health costs in an effort to reduce them is the goal for Dr. Neel Shah, who started Costs of Care, a 501(c)(3) nonprofit based in Boston, about two years ago. He is a senior resident in obstetrics and gynecology at Brigham & Women’s Hospital and Massachusetts General Hospital in Boston.  We asked him to answer some questions for a brief e-mail interview.

1. Tell us what your goal is with your Web site.

The mission of Costs of Care is to expand the national discourse on the role of doctors, nurses, and other care providers in health care spending, while empowering providers with the information they need to deflate medical bills on a grassroots level.

2. What have you learned since you started doing this?

When I started costs of care two years ago I was very focused on figuring out how to get doctors reliable cost information at the point of care. I’ve since realized that thanks to sites like ClearHealthCosts, price transparency is on the way, and our efforts may be better directed at helping doctors figure out what do with cost information once they have it. It’s not as obvious as you might think. Doctors need an infrastructure that allows them to make cost-based decisions in a way that is both ethically coherent with their impulse to do everything possible for their patients, and sufficiently pragmatic to not overburden an already complicated job.

3. We hear a lot from doctors that they are accused of overprescribing, but they are really being cautious (to insure the highest quality of care). Also doctors often say that they are induced to be over-cautious by our malpractice system, and that tort reform will go a long way toward reducing medical costs. How do you feel about that?

My opinion is not necessarily a popular one. Malpractice is a real concern but is not the only one. Last year, I made a list of the top ten reasons why doctors knowingly over-order tests on a routine basis. Many of these are solvable and don’t require waiting for tort-reform.

4. What’s the status of transparency in Massachusetts? Can you point us to some really great resources?

Yes! I’m proud to say Massachusetts allows patients to look up cost and quality information by hospital or provider for a number of common procedures. It’s not perfect, but it’s a start. There are actually 30 states that either have or are pursuing similar price transparency legislation right now, but almost all will rely on limited insurance claims data. Supplementing this information with crowdsourcing from social media will be necessary to fill in the gaps, and help filter information for relevance – this is one of the ways that ClearHealthCosts will add great value.

5. We hear a lot that doctors feel that the entire health-care financial system is broken. How do your colleagues react to costsofcare?

Doctors recognize the need to think about costs and are looking for guidance on this. According to a survey by the management consulting company Bain & Co., as many as 80% of us think controlling costs as partially our responsibility. Costs of Care recently received a grant from the American Board of Internal Medicine and Council of Medical Specialty Societies to create one of the first continuing medical education modules on cost-consciousness in medicine, and I hope our organization will play an ongoing role in helping doctors make this transition.

6. Anything else you’d like to say?

While my organization focuses on care providers, the other key to making healthcare affordable is empowering patients with information. The more engaged we are in our own health decisions, the better off everyone will be.

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Dr. Shah’s Web site is www.CostsOfCare.org; he’s also reachable via Twitter @costsofcare and on Facebook. Costs of Care is currently offering $1,000 for the best anecdotes from patients and care providers illustrating the importance of cost awareness in medicine as part of their 2011 Essay Contest.


Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...