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If doctors know how much tests cost, will they order fewer of them?


It's widely acknowledged that the U.S. health system wastes billions and billions of dollars each year.

When you're talking about that kind of money, there's plenty of blame to go around. But one area that's frequently been singled out is unnecessary testing, which an influential Institute of Medicine report last year said accounts for $210 billion in annual waste.

A new study in JAMA Internal Medicine by researchers from Johns Hopkins University suggests that that number could be reduced—at least a little bit—by making physicians aware of the cost of each test they order.

"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 additional educational interventions," the researchers write.

Notably, test-ordering doctors in the study were not offered any carrots or sticks to change their behavior, "suggesting that physicians can act in a cost-conscious manner even without direct incentives," according to the researchers.

Here's how the researchers designed the study, which took place at Johns Hopkins Hospital: They randomly assigned 61 diagnostic laboratory tests to an "active" arm, in which fees were displayed, or to a control arm, in which fees were not displayed. During a 6-month baseline period, they did not display any fee data. During a 6-month intervention period 1 year later, they displayed Medicare fees for tests in the active arm.

During the intervention period, orders dropped 9.1% on tests whose fees were displayed. In contrast, orders increased 5.1% during that period on tests whose fees were not displayed.

That 9.1% decline resulted in about $500,000 in fee savings when comparing the intervention period to the baseline period, according to the researchers.

While acknowledging that the financial impact was "modest," the researchers asserted that the 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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