We’re all well aware of the need to exercise caution when providing care, washing your hands to prevent the spread of infections and ticking other items off the checklist to avoid physically harming the patient. But what about the financial harm that clinicians can cause by making poor choices at the bedside?

That was the topic of a provocative webinar last week, hosted by the Institute for Healthcare Improvement. The realities are stark: Medical bills are the leading cause of personal bankruptcy in the United States, and an estimated $750 billion is spent each year on needless tests and treatments that add little to no value for the patient. One nonprofit, Boston-based Costs of Care, is looking to stem those trends, through advocacy, along with educating and supporting clinicians in "deflating" medical bills.

Founder and Executive Director Neel Shah, M.D., said that the conversation with the patient must change. Docs should be discussing not only the treatment options, but also how much they might cost, whether they’re covered, and if they add any value to the equation.

"Very few doctors go to medical school to treat the GDP," Shah told webinar attendees. "What we’re trying to do is reframe the conversation within the doctor-patient relationship and articulate what that means. At some level, the transaction is the elephant in the room. The problem is that it’s not made explicit at the point of care, and that’s when the vast majority of health care decisions are actually made."

Hospital leaders and their staffs can start these efforts by asking themselves a couple of key questions: Are clinicians prepared to discuss out-of-pocket costs with their patients? And what factors might help or prevent such conversations from taking place? Nurses are on the front lines and spend the most time interacting with patients, noted September Wallingford, R.N., director of nursing advocacy at Costs of Care, and a practicing nurse at Brigham and Women’s Hospital, in Boston. Every day, RNs are seeing these pieces of low-hanging fruit, in the form of unneeded tests and procedures, and are willing to speak out.

Clinicians don’t need to have an encyclopedic knowledge of prices to be able to have these conversations, Shah said. Presenters gave several examples of easy targets. Michele Rhee, director of strategic initiatives at both Costs of Care and the National Brain Tumor Society, recalled one instance when she, as a cancer patient, needed to be transported to a facility across the street after surgery. Rather than allowing her to walk over, they wanted her to take an ambulance. The doctor insisted that the transport would be covered by insurance, but instead, she later received a $1,000 bill for the ride.

"Those small decisions ended up impacting us long-term, and I ended up thinking of the cost of care as being almost a long-term side effect to the illness because we had to deal with it for so long, even after I was treated medically," she said.

We’ve written a ton on this transparency topic as of late, including exploring a new American Hospital Association guide that can help hospitals to navigate the ever-growing movement to tell customers what they owe out of pocket, before care is delivered. H&HN contributing writer Lola Butcher explored some of the price transparency trends in our June cover story. As always, feel free to share your experiences on the topic in the comments below.