The Effect of Price Information on the Ordering of Images and Procedures

Abstract

The effect of price information on ordering rates appears to depend on whether the clinician is pediatric-focused or adult-oriented.

Effectiveness of provider price display in computerized physician order entry (CPOE) on healthcare quality: a systematic review

“…Another 6 studies were added from those identified by pearling reference lists for a total of 13 studies [10][11][12][13][14][15][16][17][18][19][20][21]26 for the final analysis. The results constituted 8 randomized controlled trials, 10,12,15,16,18,20,21,26 2 interrupted time series studies, 14,19 2 controlled clinical trials 11,13 and a prospective comparative study. 17 The sequence describing the above process can be found in Figure 2.…”

“…Designs of the studies varied as described above. Randomized studies differed based on level of randomization (Four at the level of test, 15,16,21,26 2 at the level of ordering provider, 18,20 1 at the level of patient 12 and 1 at the level of physician's computer session 10 ) The population and the setting in which the studies were done also varied (Four studies done in a community outpatient setting where providers who completed graduate medical education practiced, 11,14,18,20 9 studies done in hospital and outpatient settings of teaching hospitals 10,12,13,[15][16][17]19,21,26 ) The design of the price display also varied (2 studies displayed cost data, 18,20 2 studies utilized hospital input cost, 17,19 7 studied used charge data 10,12,[14][15][16]21,26 and 2 studies displayed wholesale market price 11,13 )…”

“…27,28 Our review differs from the previous reviews in that it includes 4 additional high quality randomized controlled trials that involved >140 000 patient days in each study. 18,20,21,26 This review excluded studies done using price display on paper 8,9,37 which have usually shown significant cost savings and were included in previous reviews. This exclusion is an important departure from existing reviews as comprehension and learning especially under time constraints differ in paper and electronic screen environments (ie electronic screen based learning is inferior, termed as screen inferiority).…”

“…All 4 studies done in the community setting where physicians who completed graduate training practiced did not show any relationship between cost savings and price display. 11,14,18,20 Similarly, the 6 studies done in inpatient and outpatient settings of teaching hospitals did not find any cost savings with price display. 12,13,16,19,21,26 Two randomized controlled trials, 1 done in an inpatient 15 and 1 in an outpatient setting 10 of teaching hospitals showed cost savings with price display.…”

“…Price display on paper in the non-electronic health record era was associated with reduced costs. 8,9 Coinciding with the introduction of electronic health records (years 1990-2000) and the diffusion of EHR adoption (years 2000-2015), various authors [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] studied the impact of price display during computerized physician order entry on domains of healthcare quality such as efficiency, effectiveness, and safety. These studies differed in the setting, and design, as well as their conclusions.…”