Healthcare decisions often sound perfectly reasonable in a conference room.

A new fee. A stricter cancellation policy. A service removed from a membership. Maybe a vendor that saves money but raises uncomfortable questions about patient data.

There is usually an explanation: market conditions, operating costs, industry standards.

Now picture explaining the same decision to a patient, face to face. No presentation. No jargon. Does it still sound reasonable?

Now that’s a useful test.

The idea comes from a recent discussion about vendor ethics in Becker’s Hospital Review. One health system CIO said he asks whether he could clearly explain a vendor decision to a patient or community member and still feel comfortable with the answer.

Why limit that question to technology vendors?

Put the Patient in the Room

Before approving a price increase, an extra fee or a new policy, imagine that the patient affected by it is sitting at the table. Ask:

  • Can we explain this in plain English?
  • Will the patient know the price before agreeing?
  • Is it clear what is included and what is not?
  • Does this create value for the patient, or just move cost and hassle onto them?
  • Would we make the same choice if the patient were our mom?

None of this means a practice can never raise prices, set boundaries or make a healthy profit. A practice has to be sustainable if it is going to serve patients well. But “we need to do this for the business” should begin the explanation, not end it.

Patients are not ordinary consumers. They may be sick, frightened, short on time or unable to shop around. Medical bills are already a serious burden. In 2023, 9.6% of adults without disabilities and 21.2% of adults with disabilities were in families that had trouble paying them.

The AMA’s ethics code is direct about the priority: while caring for a patient, a physician’s responsibility to that patient is “paramount.” Federal billing protections point in the same direction. In many nonemergency situations, uninsured and self-pay patients have a right to a written good faith estimate, and they may dispute a bill that comes in at least $400 higher.

Clear pricing is more than a courtesy. It is part of treating patients fairly.

A Special Responsibility in Direct Primary Care

One of the best things about direct primary care is that the arrangement should be easy to understand. A flat monthly, quarterly or annual fee covers all or most primary care services without traditional fee-for-service insurance billing.

But simplicity is a promise that has to be maintained.

If a clear membership price comes with enrollment fees, technology fees, after-hours fees, or fuzzy exclusions, DPC starts to recreate the confusion it was meant to escape.

A patient should be able to look at one page and understand:

  • What membership costs
  • What it includes
  • What may cost extra
  • What requires outside insurance
  • How to cancel

No asterisks doing the ethical heavy lifting.

The Pre-Med Test

There is one last question. Would the pre-med version of you, the person who wanted to care for people before healthcare became a maze of contracts, codes, and margins, be proud of this decision?

That younger version of you may not have understood practice economics, but they probably understood the point of a practice.

Keep the practice healthy. Be honest about the price. Deliver value you can explain. And if you would be embarrassed to say a decision out loud to your mom, don’t hide it in the fine print.