Helping Physicians to Empower Patients

1. Are you aware that there are transparency tools available for physicians and patients to determine the price of a procedure/service and quality information for facilities? *

Additional Comments:

2. How often do you or your staff use these tools? *

Additional Comments:

3. Please select all of the quality or cost transparency tools that you use or refer patients to use: *

If quality and/or cost transparency tool is not listed, please write here:

4. How often do you or your staff refer patients to these tools? *

Additional Comments:

5. How did you determine which transparency tools to use? *

6. If you do not use cost or quality transparency tools, please share with us what prevents you from using them (please select all that apply): *

If Other, please specify:

7. In your opinion, whose responsibility is it to initiate the quality and cost discussion? *

If Other, please specify:

8. How often do you or your staff engage in cost and quality discussions with patients? *

If never, what prevents you or your staff from having this discussion with patients? (please select all that apply)

If Other, please list here:

9. How frequently do you consider patients' out-of-pocket costs when making clinical decisions or developing treatment plans? *

Additional Comments:

10. Which 3 cost or quality topics do your patients inquire about most often?

Top Inquiry * The facility they should go to for that service or procedure The provider they should go to for that service or procedure The quality of Specialists they are being referred to The quality of the Facility they are being referred to Cost of Medications The Cost of a Procedure or Service that will be done by another provider at another location The Cost of a Procedure or Service that will be done in your practice None of the above

Second most frequent inquiry * The facility they should go to for that service or procedure The provider they should go to for that service or procedure The quality of Specialists they are being referred to The quality of the Facility they are being referred to Cost of Medications The Cost of a Procedure or Service that will be done by another provider at another location The Cost of a Procedure or Service that will be done in your practice None of the above

Third most frequent inquiry * The facility they should go to for that service or procedure The provider they should go to for that service or procedure The quality of Specialists they are being referred to The quality of the Facility they are being referred to Cost of Medications The Cost of a Procedure or Service that will be done by another provider at another location The Cost of a Procedure or Service that will be done in your practice None of the above

Additional Comments:

11. Who provides guidance on where to find price information for recommended services? *

If Other, please list here:

12. Who provides guidance on where to find quality information regarding facilities and providers? *

If Other, please list here:

13. Do you want to have access to resources that facilitate constructive quality and cost conversations? *

14. Which resources would be most helpful to you and your staff during patient discussions regarding the cost and quality of services? (please select all that apply): *

If Other, please list here:

15. Which one hour webinar workshop(s) would you be interested in attending? (please select all that apply): *

If Other, please specify: