Hospitalists' awareness of patient charges associated with inpatient care

Abstract

Disclosure: Nothing to report.Hospitalists' specialized focus on inpatient care services has been conjectured to offer increased efficiency and reduce costs of inpatient care. Hospitalists' estimates of the unadjusted patient-charges generated by commonly-used services were measured. Hospitalists' agreement with one another, and accuracy relative to the actual patient-charges were both low. Hospitalists' awareness of inpatient charges appears subject to the same opacity of pricing known to limit patient knowledge, and at present hospitalists' cognizance of charges and costs is unlikely to facilitate decreased care expenditures. Hospitalists have been suggested to offer rational and efficient medical care through specialized knowledge about inpatient care services.1 The goal that hospitalists will use care resources more efficiently presumes hospitalists' accurate knowledge about charges and costs. Data regarding physicians' awareness of care charges and its impact upon care is limited. An international meta-analysis of clinicians' awareness of pharmaceutical prices demonstrated poor accuracy of physicians' estimates of charges, but effects of increasing their knowledge remained unexamined.2 Continuous exposure to education and alerts about charges have been demonstrated to diminish physicians' unnecessary use of specific laboratory assays in a single teaching hospital, in a pediatric emergency department, and an outpatient primary care system; test use declined when physicians were alerted to test charges at the point-of-care without negative impact upon clinical outcomes; when the notices ceased, utilization climbed back towards baseline levels. Specific to inpatient care, a single-center study evaluated the impact of price-alerts upon laboratory and imaging use, but showed no effects. 3-6Applicability of these existing data for contemporary hospitalists are limited, and most data were collected before hospitalists developed as an organized focus of practice. A review of existing literature revealed no published data demonstrating hospitalists' higher expert awareness of charges generated by inpatient care. Published comparisons of the care expense generated by hospitalists' care versus that of general internists or academic teams have shown minimal and inconsistent effects. [7][8][9] Those data showing reduced costs from hospitalists were associated with small length-ofstay reductions, rather than more expert resource utilization. 7 We measured the accuracy and precision of hospitalist's estimates of charges associated with services commonly used in inpatient care. SettingTwo community-based private, academic-affiliated hospitals operated by a not-for-profit health system in Washington State, comprising together 895 inpatient beds. The questionnaire instrument was approved by the governing Institutional Review Board (IRB). MethodsA list of ''true'' charges for 14 services, procedures, tests, and physician charges commonly ordered by adult medicine hospitalists was acquired directly from the responsible departm...

The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

“…1 One contributing factor to rising health care costs is that physicians rarely know the charges of the services, tests, and procedures they order or perform. 3,4 This disconnect between the trend in rising health care costs and physician lack of knowledge about the financial impact of their management decisions leads to an obvious concept for an intervention: provide a currency amount for the intervention in question for physicians when they are deciding what tests to order or what medications to prescribe. Yet, this has hardly become commonplace practice in the United States.…”

General Pediatric Attending Physicians’ and Residents’ Knowledge of Inpatient Hospital Finances

“…[11][12][13][14][15][16][17][18] The growing economic challenges confronting the health care system have led to repeated calls for competency in this domain, yet we have not witnessed this translating into improved physicians' knowledge. [11][12][13][16][17][18][19] Most studies on this topic have focused on medical students or physicians caring for adult patients. Our objective was to analyze general pediatric inpatient attending physicians' and residents' knowledge of the actual cost, charges to the patient, and insurance reimbursement for services rendered in the inpatient setting.…”

Description and Evaluation of an Educational Intervention on Health Care Costs and Value

“…[5][6][7] Thus in 2011, the American College of Physicians issued a statement emphasizing an urgent need for physicians to receive training in providing cost-conscious care and decreasing unnecessary care that does not benefit patients. 8 Because there was no organized curriculum geared toward helping pediatricians enhance their competency in providing highvalue, cost-conscious care, the Children' s Hospital of Philadelphia (CHOP) began a multiyear project to develop and implement a curriculum for faculty and trainees on these topics.…”