Impact of Providing Fee Data on Laboratory Test Ordering

Feldman, Leonard; Shihab, Hasan M; Thiemann, David R.; Yeh, Hsin Chieh; Ardolino, Margaret; Mandell, Steven F.; Brotman, Daniel J.

doi:10.1001/jamainternmed.2013.232

Cited by 180 publications

(156 citation statements)

References 27 publications

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“…[23][24][25][26][27] Of the seventeen studies, seven were randomized controlled trials, 11,12,14,19,23,24,26 eight were pre-intervention vs. postintervention studies, 15,16,18,[20][21][22]25,27 and two had a concurrent control and intervention groups, but were not randomized. 13,17 Eleven studies examined physician ordering of laboratory or radiology testing, [11][12][13][14][15][16][17][18][19]23,24 while six looked at medication choice. [20][21][22][25][26][27] The details of the study design, study size, bias considerations, and follow-up period for the included studies are summarized in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…There were a total of nine papers in this category: four randomized controlled trials, 11,12,14,19 two non-randomized controlled trial, 13,17 and three pre-intervention vs. post-intervention studies 15,16,18 that looked at test ordering. Four interventions were conducted in inpatient wards [11][12][13][14] two were conducted in emergency department, 15,17 two were in intensive care units, 16,18 and one was in an internal medicine outpatient clinic. 19 Six were conducted in the United States 11,12,[14][15][16]19 ; studies were also conducted in South Africa, 13 Sweden, 17 and France.…”

Section: Interventions In a Clinical Settingmentioning

confidence: 99%

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

Rotman

Hartoularos

et al. 2015

J GEN INTERN MED

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BACKGROUND: While studies have been published in the last 30 years that examine the effect of charge display during physician decision-making, no analysis or synthesis of these studies has been conducted. OBJECTIVE: We aimed to determine the type and quality of charge display studies that have been published; to synthe-size this information in the form of a literature review. METHODS: English-language articles published between 1982 and 2013 were identified using MEDLINE, Web of Knowledge, ABI-Inform, and Academic Search Premier. Article titles, abstracts, and text were reviewed for relevancy by two authors. Data were then extracted and subsequently synthesized and analyzed. RESULTS: Seventeen articles were identified that fell into two topic categories: the effect of charge display on radiology and laboratory test ordering versus on medication choice. Seven articles were randomized controlled trials, eight were pre-intervention vs. post-intervention studies, and two interventions had a concurrent control and intervention groups, but were not randomized. Twelve studies were conducted in a clinical environment, whereas five were survey studies. Of the nine clinically based interventions that examined test ordering, seven had statistically significant reductions in cost and/or the number of tests ordered. Two of the three clinical studies looking at medication expenditures found significant reductions in cost. In the survey studies, physicians consistently chose fewer tests or lower cost options in the theoretical scenarios presented. CONCLUSIONS: In the majority of studies, charge information changed ordering and prescribing behavior.KEY WORDS: charge display; physician behavior; costs of care.

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Section: Resultsmentioning

confidence: 99%

Section: Interventions In a Clinical Settingmentioning

confidence: 99%

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

Rotman

Hartoularos

et al. 2015

J GEN INTERN MED

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“…Two recent studies have demonstrated that displaying costs in the electronic order entry system reduced the ordering of lab tests. 31,32 Hospitals could improve the availability of, and potentially even require participation in, continuing medical education focused on cost-conscious care. Technology could be utilized to help disseminate best practices and educational materials from hospitals with demonstrated success in this area to institutions with fewer resources.…”

Section: Discussionmentioning

confidence: 99%

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

et al. 2015

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BACKGROUND:Little is known about how well faculty at teaching hospitals role-model behaviors consistent with cost-conscious care. OBJECTIVE: We aimed to evaluate whether residents and program directors report that faculty at their program consistently role-model cost-conscious care, and whether the presence of a formal residency curriculum in costconscious care impacted responses. DESIGN: Cost-conscious care surveys were administered to internal medicine residents during the 2012 Internal Medicine In-Training Examination and to program directors during the 2012 Association of Program Directors in Internal Medicine Annual Survey. Respondents stated whether or not they agreed that faculty in their program consistently role-model cost-conscious care. To evaluate a more comprehensive assessment of faculty behaviors, resident responses were matched with those of the director of their residency program. A multivariate logistic regression model was fit to the outcome variable, to identify predictors of responses that faculty do consistently rolemodel cost-conscious care from residency program, resident, and program director characteristics. PARTICIPANTS: Responses from 12,623 residents (58.4 % of total sample) and 253 program directors (68.4 %) from internal medicine residency programs in the United States were included. MAIN MEASURES: The primary outcome measure was responses to questionnaires on faculty role-modeling cost-conscious care. KEY RESULTS: Among all responses in the final sample, 6,816 (54.0 %) residents and 121 (47.8 %) program directors reported that faculty in their program consistently role-model cost-conscious care. Among paired responses of residents and their program director, the proportion that both reported that faculty do consistently rolemodeled cost-conscious care was 23.0 % for programs with a formal residency curriculum in cost-conscious care, 26.3 % for programs working on a curriculum, and 23.7 % for programs without a curriculum. In the adjusted model, the presence of a formal curriculum in costconscious care did not have a significant impact on survey responses (odds ratio [OR] were not consistently role-modeling cost-conscious care. The presence of a formal residency curriculum in costconscious care did not impact responses. Future efforts should focus on placing more emphasis on faculty development and on combining curricular improvements with institutional interventions to adapt the training environment.

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“…5,11,12 However, results from early attempts to encourage physicians to provide lower cost medications through decision support tools have had mixed success. A study by Ornstein et al 13 reported that providing medication cost information in the EHR of a family-practice clinic did not change the overall cost of medications prescribed.…”

Section: Introductionmentioning

confidence: 99%

Yelp for Prescribers: A Quasi-Experimental Study of Providing Antibiotic Cost Data and Prescription of High-Cost Antibiotics in an Academic and Tertiary Care Hospital

et al. 2015

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BACKGROUND: Physicians frequently prescribe antibiotics to inpatients without knowledge of medication cost. It is not well understood whether providing cost data would change prescribing behavior. OBJECTIVE: To evaluate the association between providing cost data alongside culture and antibiotic susceptibility results and prescribing of high-cost antibiotics. DESIGN: Quasi-experimental pre-post analysis. PARTICIPANTS: Inpatients diagnosed with bacteremia or urinary tract infection in two tertiary care hospitals. INTERVENTION: Cost category data for each antibiotic ($, $$, $$$, or $$$$) were added to culture and susceptibility testing results available to physicians. MAIN MEASURES: Average cost category of antibiotics prescribed to patients after the receipt of susceptibility testing results. KEY RESULTS: There was a significant decrease in the average cost category of antibiotics per patient after the intervention (pre-intervention = 1.9 $ vs. postintervention = 1.7 $, where 1.5 $ would mean that the average number of dollar signs for antibiotics prescribed was between $ and $$, p=0.002). After adjusting for age, insurance type, and prior length of stay, the odds ratio (OR) of a patient's average antibiotic being higher cost vs. lower cost after the intervention compared to before the intervention was 0.74 [95 % confidence interval (CI) 0.56, 0.98]. The intervention was associated with a 31.3 % reduction in the average cost per unit of antibiotics prescribed (p<0.001). CONCLUSIONS: Providing physicians with cost feedback alongside susceptibility testing data was associated with a significant decrease in prescription of high-cost antibiotics. This intervention is intuitive, low cost, and may shift providers toward lower cost medications when equally acceptable options are available.KEY WORDS: infectious disease; hospital medicine; health care costs, medical decision making.

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Impact of Providing Fee Data on Laboratory Test Ordering

Cited by 180 publications

References 27 publications

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

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

Role-Modeling Cost-Conscious Care—A National Evaluation of Perceptions of Faculty at Teaching Hospitals in the United States

Yelp for Prescribers: A Quasi-Experimental Study of Providing Antibiotic Cost Data and Prescription of High-Cost Antibiotics in an Academic and Tertiary Care Hospital

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