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The Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering

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ABSTRACT

BACKGROUND

Physicians are under increased pressure to help control rising health care costs, though they lack information regarding cost implications of patient care decisions.

OBJECTIVE

To evaluate the impact of real-time display of laboratory costs on primary care physician ordering of common laboratory tests in the outpatient setting.

DESIGN

Interrupted time series analysis with a parallel control group.

PARTICIPANTS

Two hundred and fifteen primary care physicians (153 intervention and 62 control) using a common electronic health record between April 2010 and November 2011. The setting was an alliance of five multispecialty group practices in Massachusetts.

INTERVENTION

The average Medicare reimbursement rate for 27 laboratory tests was displayed within an electronic health record at the time of ordering, including 21 lower cost tests (< $40.00) and six higher cost tests (> $40.00).

MAIN MEASURES

We compared the change-in-slope of the monthly laboratory ordering rate between intervention and control physicians for 12 months pre-intervention and 6 months post-intervention. We surveyed all intervention and control physicians at 6 months post-intervention to assess attitudes regarding costs and cost displays.

KEY RESULTS

Among 27 laboratory tests, intervention physicians demonstrated a significant decrease in ordering rates compared to control physicians for five (19 %) tests. This included a significant relative decrease in ordering rates for four of 21 (19 %) lower cost laboratory tests and one of six (17 %) higher cost laboratory tests. A majority (81 %) of physicians reported that the intervention improved their knowledge of the relative costs of laboratory tests.

CONCLUSIONS

Real-time display of cost information in an electronic health record can lead to a modest reduction in ordering of laboratory tests, and is well received. Our study demonstrates that electronic health records can serve as a tool to promote cost transparency and reduce laboratory test use.

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Acknowledgements

We thank Shane Morong, BA for assistance with survey distribution and survey data acquisition and analysis.

Funding/Support

This study was not funded by any outside sponsors.

Prior Presentations

A portion of this data was presented as a plenary talk at the Society for General Internal Medicine Annual Meeting in Orlando, Florida on May 12, 2012.

 Thomas D. Sequist had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Conflict of Interest Disclosures

The authors declare that they do not have any conflicts of interest.

Author information

Authors and Affiliations

  1. Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA

    Daniel M. Horn MD

  2. Harvard Vanguard Medical Associates and Atrius Health, Newton, MA, USA

    Kate E. Koplan MD, MPH, Margaret D. Senese MS & Thomas D. Sequist MD, MPH

  3. Division of General Medicine, Brigham and Women’s Hospital, 1620 Tremont Street, Boston, MA, 02120, USA

    E. John Orav PhD & Thomas D. Sequist MD, MPH

  4. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Thomas D. Sequist MD, MPH

Authors
  1. Daniel M. Horn MD
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  2. Kate E. Koplan MD, MPH
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  3. Margaret D. Senese MS
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  4. E. John Orav PhD
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  5. Thomas D. Sequist MD, MPH
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Corresponding author

Correspondence to Thomas D. Sequist MD, MPH.

Appendix 1

Appendix 1

Table 5 Impact of Laboratory Cost Displays on Physician Ordering Rates (Nonsignificant Labs)*
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Horn, D.M., Koplan, K.E., Senese, M.D. et al. The Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering. J GEN INTERN MED 29, 708–714 (2014). https://doi.org/10.1007/s11606-013-2672-1

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  • DOI: https://doi.org/10.1007/s11606-013-2672-1

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