Deborah D. Gordon, MBA Mossavar-Rahmani Center for Business and Government Harvard Kennedy School Cambridge, Massachusetts

Even in Intensive Care, Health Care Costs Are Factor For Both Patients and Clinicians Interview with:

Deborah D. Gordon, MBA Mossavar-Rahmani Center for Business and Government Harvard Kennedy School Cambridge, Massachusetts

Deborah  Gordon

Deborah D. Gordon, MBA
Mossavar-Rahmani Center for Business and Government
Harvard Kennedy School
Cambridge, Massachusetts What is the background for this study? What are the main findings?

Response: Against the backdrop of rising health care costs, and the increasing share of those costs that consumers bear, studies show people are interested in finding health care cost information and engaging with their providers on issues of cost.

We were interested in learning to what extent, if any, discussion or consideration of cost would be documented in electronic health records.

Using machine learning techniques to extract data from unstructured notes, we examined 46,146 narrative clinical notes from ICU admissions. We found that approximately 4% of admissions had at least one note with financially relevant content. That financial content included documentation of cost as a barrier to adhering to treatment prior to admission, and as a consideration in treatment and discharge planning. What should readers take away from your report?

Response: Conventional wisdom holds that in emergencies and high-acuity health situations, people are simply too vulnerable to focus on the cost of care. However, our findings call those assumptions into question. Thus, the key take-away is that cost is a factor for many patients and clinicians even in the ICU, suggesting both need and opportunity for providers and staff to proactively address patient cost concerns.

Both health care professionals and patients could benefit from tools and personal competencies in discussing, interpreting, and negotiating health care costs regardless of care setting. What recommendations do you have for future research as a result of this work? 

Response: To further understand the prevalence of cost conversations and considerations outside of the ICU, we are analyzing outpatient data to determine if cost considerations are more prevalent in documentation of care in different settings.

This study also revealed what are likely inadvertent cost drivers, such as patients staying in the ICU longer than clinically necessary due to pending insurance decisions about rehabilitation or other post-discharge approaches. Quantifying the costs of such delays could be a valuable contribution to illuminating opportunities for health care providers and institutions to reduce unnecessary medical expense. Is there anything else you would like to add?

Response: As market and regulatory forces have shifted health care cost burdens increasingly onto patients, costs will likely become a greater factor in clinical encounters. Though factoring costs more explicitly would be a departure from historical norms, engaging in costs conversations will be important for health care providers to understand their patients’ holistic experience, and may be important to ensuring adherence to treatment plans.


Gordon DD, Patel I, Pellegrini AM, Perlis RH. Prevalence and Nature of Financial Considerations Documented in Narrative Clinical Records in Intensive Care Units. JAMA Netw Open. 2018;1(7):e184178. doi:10.1001/jamanetworkopen.2018.4178 

[wysija_form id=”3″]

Nov 6, 2018 @ 1:13 am


The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.