Internal Medicine Physicians' Knowledge of Health Care Charges

Sehgal, Raj; Gorman, Paul

doi:10.4300/jgme-d-10-00186.1

Cited by 43 publications

(40 citation statements)

References 22 publications

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“…Several recent articles from various specialties have highlighted how little physicians know about the costs of services they render [1,[23][24][25][26][27][28][29]. Most radiology trainees, for example, cannot estimate the cost of common imaging studies within even 50% of Medicare-allowable fees [30].…”

Section: Introductionmentioning

confidence: 99%

Practice Management and Health Policy Education in Radiology: An Emerging Imperative

DeQuesada

Chokshi

Mullins

et al. 2015

Journal of the American College of Radiology

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Section: Introductionmentioning

confidence: 99%

Practice Management and Health Policy Education in Radiology: An Emerging Imperative

DeQuesada

Chokshi

Mullins

et al. 2015

Journal of the American College of Radiology

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“…Cost containment and cost-effectiveness have not been a traditional part of residency training, 18 and physicians are frequently unaware of the costs of tests they order. 19 Furthermore, the real pressures of patient expectations and defensive medicine encourage test ordering. 20,21 The opposite pressures to reduce laboratory costs are not generally felt nor are they routinely tracked on an individual physician basis.…”

mentioning

confidence: 99%

House Officer–Driven Reduction in Laboratory Utilization

Tawfik¹,

Collins²,

Fino³

et al. 2016

Southern Medical Journal

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Objectives To determine whether sharing laboratory charge and personal utilization information with physicians can reduce laboratory test orders and expenditures, thereby decreasing the overutilization of laboratory testing. Methods This was a prospective study. By querying our electronic medical records, we calculated the median laboratory charges per patient/per day (PP/PD) and median laboratory tests ordered PP/PD for the resident general internal medicine and hospitalist services. For 10 weeks, we shared this team-based information with physicians with weekly updates. We calculated total laboratory charges for the 10 most common discharge diagnoses to capture laboratory charges for entire episodes of care. Results During the intervention, the mean number of laboratory tests ordered PP/PD by resident service decreased from 5.56 to 5.17 (−0.389, P <0.001); the mean charge PP/PD decreased from $488 to $461 (−$27, P < 0.001). The hospitalist service decreased the number of laboratory tests ordered PP/PD from 3.54 to 3.36 (−0.18, P = 0.77) and the mean charge PP/PD decreased from $331 to $301 (−$30, P = 0.96). The statistically significant decline in laboratory charges persisted after controlling for the 10 most common discharge diagnoses. Compared with the 3-month period before the study began, physicians in the 10-week intervention period ordered 1464 fewer laboratory tests, resulting in a $188,000 reduction in charges and a 3% to 4% reduction in utilization. Conclusions Informing physicians of the charges for laboratory tests and their personal utilization patterns can reduce the number of laboratory tests ordered and laboratory expenditures, especially for physicians in training.

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“…The Accreditation Council for Graduate Medical Education (ACGME) includes cost awareness as a core competency of EM training, although this is recognized as an area of improvement 5,6. Knowledge of the actual cost of diagnostic testing among EM residents has not been studied, and the specific educational needs in this area are not known.…”

Section: Introductionmentioning

confidence: 99%

Can Emergency Medicine Residents Predict Cost of Diagnostic Testing?

Tainter¹,

Gentges²,

Thomas³

et al. 2017

WestJEM

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IntroductionDiagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests. Needless and excessive spending may occur without an appreciation of the impact on the larger healthcare system. Knowledge regarding the cost of diagnostic testing among emergency medicine (EM) residents has not previously been studied.MethodsA survey was administered to 20 EM residents from a single ACGME-accredited three-year EM residency program, asking for an estimation of patient charges for 20 commonly ordered laboratory tests and seven radiological exams. We compared responses between residency classes to evaluate whether there was a difference based on level of training.ResultsThe survey completion rate was 100% (20/20 residents). We noted significant discrepancies between the median resident estimates and actual charge to patient for both laboratory and radiological exams. Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs $57, and for computed tomography exams was $1,058. There was improvement in accuracy with increasing level of training.ConclusionThis pilot study demonstrates that EM residents have a poor understanding of the charges burdening patients and health insurance providers. In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula, and warrants further attention and investigation.

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Internal Medicine Physicians' Knowledge of Health Care Charges

Abstract: Internal medicine physicians poorly estimate the charges for diagnostic tests but have a strong desire to improve their knowledge, suggesting a possible intervention to improve the cost-effectiveness of medical care.

Cited by 43 publications

References 22 publications

Practice Management and Health Policy Education in Radiology: An Emerging Imperative

Practice Management and Health Policy Education in Radiology: An Emerging Imperative

House Officer–Driven Reduction in Laboratory Utilization

Can Emergency Medicine Residents Predict Cost of Diagnostic Testing?

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