Original articleProvider Cost Transparency Alone Has No Impact on Inpatient Imaging Utilization
Section snippets
Study Setting and Design
Institutional review board approval was obtained to conduct this study at our home institution, a 1,025-bed tertiary care academic teaching hospital. We surveyed the inpatient CPOE data from the fiscal year 2007, identified the 10 most frequently ordered imaging tests, and randomly assigned 5 of them to the active cost display group and 5 to the control group, using web-based software (http://www.randomization.com). During a 6-month baseline period (November 10, 2008, to May 9, 2009), no cost
Results
Table 1 summarizes the baseline characteristics of the imaging tests within the active and control groups. Detailed summaries of the ordering behavior for each test during the baseline and intervention periods are provided in Table 2, Table 3, respectively. The relative utilization change between the two periods for all tests and the mean relative utilization change for each group are summarized in Table 4. Notably, the mean relative utilization change for tests in the active group was +2.8 ±
Discussion
Our intervention was designed to answer a common question of interest to radiologists and health care economists: Would physicians order fewer imaging tests if they were aware of the costs? In the context of this study, we found that the answer was “no”: Provider cost transparency alone did not influence inpatient imaging utilization or its associated costs in any significant fashion. Specifically, the large decreases in laboratory test utilization due to provider cost transparency reported
Take-Home Points
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Many current and future health care system reforms at the state and federal levels are based on increasing cost transparency to eliminate market distortions.
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It has been shown that presenting care providers with cost information at the point of order entry reduces utilization of certain laboratory tests by up to 27%.
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At our center, integrating cost information for common imaging tests into the CPOE system did not significantly influence their utilization.
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Our trial was powered to detect changes
Acknowledgment
The authors thank Gloria Vila for her assistance with this report.
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Dr Durand receives salary support from the Research & Education Fund of the Radiological Society of North America (Oak Brook, Ill) and travel support from the Walter and Mary Ciceric Research Award. Drs Brotman and Feldman received support for this work from the Johns Hopkins Hospitalist Scholars Fund.