In the study, physicians and others who ordered lab tests through the computerized order entry system at the Johns Hopkins Hospital were tracked over a six-month period in late 2008 and early 2009 and then again for another six months in late 2009 and early 2010 on how they ordered a selected group of 61 lab tests. Roughly half were chosen from the most frequent tests ordered at the hospital, and the other half, the most expensive.
In the earlier study period, none of the tests had their costs displayed with them. But in the second study period, one group, the control group, continued to go “priceless” when ordering, while a second group, called the “active arm,” had their Medicare allowable fee available when ordering. In all, nearly 1.2 million tests were ordered.
The researchers compared records between the control and active groups for the total number of orders placed, the frequency of tests ordered per day and the total charges associated with those orders.
They found that, in the test group, when prices weren't made available, the providers ordered 3.7 tests per patient day, but later, when the prices were linked, the number of tests per patient day fell to 3.4, a drop of nearly 8.6%.
In contrast, the number of tests in the control group, those without pricing in both test periods, rose by 5.1%.
Test costs followed a similar path. For the test group with prices, the cost per patient day fell $3.79, for a drop of 9.6%. Meanwhile, in the control group, charges per patient day rose by $0.52 per patient day, or by 2.9%.
“Our findings suggest that simply displaying the Medicare allowable fee of diagnostic laboratory tests at the time of order entry can affect physician ordering behavior, even without any educational interventions,” the authors concluded. “Although the 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.”
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