At a time when labs and hospitals are working with providers to curb unnecessary diagnostic testing, a study reveals that simply displaying the cost of a test has little effect on clinician ordering behaviors.
The study’s authors published their findings in JAMA Internal Medicine and discussed the results at the Society of General Internal Medicine annual meeting in Washington, D.C.
“Price transparency is increasingly being considered by hospitals and other healthcare organizations as a way to nudge doctors and patients toward higher-value care, but the best way to design these types of interventions has not been well-tested,” said senior author Mitesh S. Patel, MD, MBA, MS, an assistant professor of medicine and of healthcare management at the University of Pennsylvania’s Perelman School of Medicine and the Wharton School, in statement.
To assess the impact of price transparency on ordering behaviors, the investigators conducted a randomized clinical trial at several hospitals in the University of Pennsylvania Health System in Philadelphia. They randomly divided 60 groups of inpatient lab tests into an intervention group, in which electronic health records (EHRs) displayed Medicare allowable fees, and a control group, for which EHRs did not display this information. Investigators looked at EHRs for 98,529 patients, comparing ordering behaviors and associated fees one year before and during the year interventions took place.
Pre-intervention, tests averaged 3.93 a day, with associated fees totaling $37.84 in the intervention group. During the one-year intervention period in which clinicians were able to see cost information, averages for the number of tests and related costs went up only slightly in the intervention group: 4.01 tests totaling $38.85 daily.
Similarly, the number of tests and related costs for the control group averaged 2.31 tests totaling $27.77 daily prior to the study, and 2.34 tests totaling $27.59 after the study.
Although displaying pricing information didn’t significantly affect overall numbers, the investigators in their analysis noticed a small but significant decline in test ordering for patients in the Intensive Care Unit (ICU) after the intervention, compared with patients who didn’t stay in the ICU.
“This may have been because physicians were more exposed to the price transparency intervention,” Patel told CLN Stat. “In the ICU, decisions are made more rapidly, and so physicians are less likely to rely on repeating labs. This increased exposure to the prices could have influenced their behavior.”
How prices are framed surfaced as another influential factor. Investigators noticed that doctors after the intervention were ordering more inexpensive tests and fewer of the pricier tests. “If the price of a test was higher than expected, you might order less of it. If it was less expensive than expected, you might order more of it,” according to Patel. He suggested that future interventions involving price transparency “may need to be better targeted, framed, or combined with other approaches to be more successful.”
Other experts believe that price transparency, aligned with the proper strategies, could serve as a useful tool for doctors and patients alike. “Studies of physicians consistently find that physicians are not only interested in helping patients reduce their out-of-pocket spending burdens, but they feel morally obligated to do so,” wrote Anna D. Sinaiko, PhD, and Alyna T. Chien, MD, MS, in a related editorial.
To get patients and physicians on the same page with respect to price information, doctors should receive timely information on their patients’ out-of-pocket costs. Price transparency interventions to patients and doctors should also be delivered at the same point in the healthcare continuum.
“Currently, individuals are made aware of transparency tools through initial marketing campaigns, and perhaps annually thereafter, but little has been done to deliver salient price information to patients at the time when patients are making healthcare decisions. In contrast, price information for physicians is delivered at the point of care, where it likely to be more useful in making choices,” they observed.