Primary care doc: It’s “crazy” that doctors don’t consider costs in patient treatment plans

11:26 am by | 3 Comments

It’s not just patients who are seeking price transparency.

For years, Leslie Ramirez, 46, a primary care, internal medicine doctor in Chicago, , has been frustrated by patients who do not adhere to her care program because they can’t afford to buy a particular medication or undergo a certain test.

“It was so disheartening to hear that the plans that I had made for them weren’t being followed because they couldn’t afford the things that I was telling them to do,” Ramirez, who sees a fair number of uninsured and underinsured patients, said in a recent interview. “Professionally it’s a very unsatisfying experience to try and come up with a solution for a patient and go through all the time, the energy and the brain power and then the next time you see them nothing is different because they couldn’t afford your solution.”


Things came to a head in late 2008 when her mother, who was in between jobs in Dallas, decided to skip a mammogram because she couldn’t pay the $400 she was being charged. Ramirez did a little market research and found that the same exact test was being offered elsewhere for $100.

A few months later in March 2009, Leslie’s List was born. Dedicated to price transparency and patient empowerment, the website publishes information of low-priced testing, low-priced medication and free clinics in the Chicago and Dallas areas.

Ramirez has hired two people to gather the information in addition doing some market research on her own time. The effort is fully funded by her. The website has no revenue model. In fact Ramirez said she investigated various business models but came away convinced that none of those put patients first.

“Any business model where we felt we weren’t giving the best information to the patient, is not going to work,” she said.

In thinking about the cost equation in caring for patients, Ramirez is departing from how doctors traditionally practice medicine. In most cases, they prefer not to be affected by base considerations such as money that may cloud their ability to provide high quality care.

Ramirez disagrees vehemently.

It’s funny because I was talking to a colleague of mine who is in his mid forties and he said he was actually told by his professors [in medical school] that pricing should never be a consideration in your caring for a patient because then you have the potential for not providing the best care.

But to me that’s nonsense. You can come up with the best care plan in the world, but if the patient can’t afford it, who cares?

It’s completely crazy to think that patients are going to pay any price. They are not going to pay any price. They have to put food on the table. People have to get stuff for their kids.

Cost consideration has been especially true in the 2008 recession and slow recovery. In fact, a recent report released by Consumer Reports found that in 2012, 45 percent of patients lacking a prescription drug benefit who were under 65, decided to skip filling their prescription because of cost, compared with 27 percent last year.

Ramirez wants to help empower these patients by collecting data on her website to show where the cheapest medications and tests are available. Leslie’s List will shortly launch in New York City and Ramirez is partnering with a doctor in Flint, Michigan to launch something similar there. Her focus is to be in large cities where there is a significant uninsured population.

“Absolutely this is to empower the patient, first and foremost,” Ramirez said. “If I am dreaming big here, I hope to jam the prices down just like we saw with airline tickets. Once there is price transparency, the natural order of things in our happy, capitalist, free market society is that then the price comes down.”

Ramirez said she has achieved that in one instance. The way the Leslie’s List website works is that the cheapest price of a medication or test comes up first, with the most expensive at the bottom of the list.

“We have been contacted by [someone from] an MRI center who said ‘I know we said our price was X but now we want to discount that price further and make it Y.’ When I plugged that number in, the price moved them to the top of the list. That’s why they did that.”

Copyright 2015 MedCity News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Arundhati Parmar

By Arundhati Parmar

Arundhati Parmar is the Medical Devices Reporter at MedCity News. She has covered medical technology since 2008 and specialized in business journalism since 2001. Parmar has three degrees from three continents - a Bachelor of Arts in English from Jadavpur University, Kolkata, India; a Masters in English Literature from the University of Sydney, Australia and a Masters in Journalism from Northwestern University in Chicago. She has sworn never to enter a classroom again.
More posts by Author


Patients are increasingly responsible for their medical bills as co-insurance and high deductible health insurance continue to gain market share. Doctors need to adapt to this "new normal" and follow Dr. Ramirez's lead here. She correctly observes that price sensitivity will be of growing importance in patient compliance and choice of treatments. Doctors need to abandon their vestigial mindset of being "above" such things if they wish to serve their patients properly. Now let's get this model replicated nationally.


Dr Ramiriz is definitely doing the right thing. There is no reason for doctors to not take cost into consideration. I have personally found that since I started with a high deductible policy, I am much more likely to question my physician about the cost of a drug, test, etc. or to challenge whether it is really needed or if will be actually used to affect treatment. Once I was given a prescription for Nasonex and found that it cost $97. So I asked about an alternative - Flonase for $7. No problem said the doc; “I picked Nasonex because I had some samples in the office.” Or the time it was suggested that I have a follow-up test to see how my vocal cords looked after a treatment process had worked. But I suggested that the $700 test was not needed since my symptoms of hoarseness were gone. The speech pathologist agreed. So we as patients need to ask questions and a site like that of Dr Ramiriz greatly helps with that process.Stephen Schimpff, MD