Table 2

Numbers of errors and bases for cost estimates by service missed or used unnecessarily in each variant

CaseServiceCPTCost (US$)Type and number of errors by variant
Worsening asthmaAdditional inhaler (symbicort) 163.79M=9M=1
Switch to generic inhaler (symbicort) 163.79 M=13M=14
Prescribe anti-acid RX (20 mg omeprazol) 29.99U=1M=22U=1M=16
Cardiology/pulmonary referral99 203158.67 U=1
Social work consult, 1 h 30.00 M=14M=15
Chest x-ray71 02083.35U=3U=1
HypertensionTSH84 44323.47U=6M=14U=4M=14
Care for disabled child to permit surgery ($95/day) 2850.00 M=20M=23
SyncopeAdjust insulin dose (Humulin R) 46.99M=6 M=2M=1
Stress ECHO93 350640.08U=2M=8U=2M=7
Cardiac stress test93 017244.07U=3 U=4
ECHO93 312895.59U=3 U=2
Cardiology/pulmonary referral99 203158.67U=1M=8U=0M=7
24 h Holter monitor93 225115.94U=3 U=5
30-day event monitor93 270103.75U=1 U=2
Carotid dopplers93 880451.61 U=1
Chest x-ray71 02083.35U=1 U=1
Cardio loop recorder test93 270103.75 U=1
Thyroid function tests (TSH, Total T3, Total T4)84 44348.51U=1
84 480
84 436
Prescribe β blocker (50 mg Toprol XL) 35.99U=2
Prescribe isosorbide mononitrate 46.99U=1
Novolog FlexPen ($199.27) and training (nurse, 1 h, $32) 231.27 M=20M=17
Glucometer (OneTouch with test strips) 126.99M=6 M=2M=1
Weight lossChest x-ray71 02083.35MissedU=12U=11U=16
CT abdomen74 150519.94 U=2U=1U=1
CT pelvis72 192520.51 U=2U=1U=1
CT thorax71 250532.10 U=2 U=1
ECHO93 312895.59 U=1
Ultrasound abdomen76 700248.62 U=1
Labs for malignancy 83.35M=1
HIV test86 689144.26 U=1
Treatment for depression (30 mg Paxil), referral 47.00 M=4 M=4
Social work consult, 1 h 30.00 M=14M=22
  • Costs are in 2009 US$ and based on a 30-day time horizon. Costs associated with CPT codes are based on Medicare reimbursement schedules and include both facility and professional cost; drug costs are based on Medicare average sales price. ‘M’ indicates that the service should have been provided in the variant, and errors are the number of encounters in which it was missed. ‘U’ indicates that the service should not have been provided in the variant, and errors are the number of encounters in which it was unnecessarily provided. Empty cells indicate no errors made (either service was appropriate and never missed, or inappropriate and never unnecessarily provided).

  • CPT, Current Procedural Terminology; ECHO, echocardiogram; TSH, thyroid-stimulating hormone.