Original article
Provider Cost Transparency Alone Has No Impact on Inpatient Imaging Utilization

https://doi.org/10.1016/j.jacr.2012.06.020Get rights and content

Purpose

The aim of this study was to determine whether presenting providers with cost information at the point of order entry significantly influences imaging utilization.

Methods

Using data from fiscal year 2007, the 10 most frequently ordered imaging tests were identified. Five of these were randomly assigned to the active cost display group and 5 to the control group. During a 6-month baseline period from November 10, 2008, to May 9, 2009, no costs were displayed. During a seasonally matched intervention period from November 10, 2009, to May 9, 2010, costs were displayed only for tests in the active group. At the conclusion of the study, the radiology information system was queried to determine the number of orders executed for all tests during both periods. The main outcome measure was the mean relative utilization change between the control and intervention periods for the active group vs the control group. An additional measure was the correlation between test cost and utilization change in the active group vs the control group.

Results

The mean utilization change was +2.8 ± 4.4% for the active group and −3.0 ± 5.5% for the control group, with no significant difference between the two groups (P = .10, Student's t-test). There was also no significant difference in the correlation between test cost and utilization change for the active group vs the control group (P = .25, Fisher's z-test). On the basis of the observed standard deviations, this study had 90% power to detect an 11.8% difference in mean relative utilization change between groups.

Conclusions

Provider cost transparency alone does not significantly influence 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

  • Many current and future health care system reforms at the state and federal levels are based on increasing cost transparency to eliminate market distortions.

  • 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%.

  • At our center, integrating cost information for common imaging tests into the CPOE system did not significantly influence their utilization.

  • Our trial was powered to detect changes

Acknowledgment

The authors thank Gloria Vila for her assistance with this report.

References (14)

There are more references available in the full text version of this article.

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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.

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