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Tuesday, April 16, 2013

Does knowing the cost of tests change physicians' decisions?

If you don't know how much the ribeye costs at the restaurant, are you still likely to order it?

Health care advocates are continuing to push for greater "transparency" in how consumers make decisions on their care, such as knowing how much certain procedures cost at various outpatient clinics or hospitals.

But what about doctors? Often, they don't know the prices either. They may order expensive tests due to clinical preference, medical defensiveness, or because past test results aren't easily available.

A group of researchers at The Johns Hopkins University School of Medicine decided to see whether physician ordering behavior would change if physicians actually saw the cost of certain lab tests before ordering them.

In a study published online this week in JAMA Internal Medicine, the group said it saw a 9.1 percent decrease in orders over six months for an "active" group of 30 lab tests for which physicians could see the Medicare allowable charge in the hospital's computer ordering system.

Orders for a "control" group of 31 tests, which lacked pricing information, rose 5.1 percent during the study period.

The smaller number of tests in the "active" group represented a $436,115 decrease in hospital charges.

"Although the overall financial impact is modest, our study offers evidence that presenting providers with associated test fees as they order is a simple and unobtrusive way to alter behavior," the authors said, noting also the study involved no other educational intervention or incentives.

They added that it's unclear how order reductions and savings would play out over multiple years, whether doctors would eventually ignore the prices and those changes would disappear, or whether the quality of patient care declined because of the lower testing.

But they said it was a promising area of future study considering that imaging and diagnostic testing increased 85 percent between 2000 and 2009 and multiple studies and public information efforts have identified reducing waste as one of the best ways to corral U.S. health care spending.

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