Providers order slightly fewer laboratory tests when presented with cost information at the time of ordering, and adopting this tactic on a widespread basis might help reduce the number of inappropriately ordered diagnostic tests, researchers from Johns Hopkins University found.
Dr. Leonard S. Feldman and his colleagues compared ordering behavior among all providers, including nonphysicians, who ordered 61 lab tests through the computerized order entry system at the Johns Hopkins Hospital in Baltimore during a baseline period and an intervention period. During the intervention period, Medicare-allowable fees were displayed for 30 of the 61 lab tests.
Orders for the tests with cost data displayed fell 9% during the intervention period, and the number of tests per patient-day decreased as well, from 3.72 to 3.40 (about 9%), the researchers found. Meanwhile, orders for the 31 tests without cost data rose 5% during the intervention period when compared with the baseline period, and tests per patient-day increased nearly 6% (JAMA Intern. Med. [doi:10.1001/jamainternmed.2013.232]).
Overall, the hospital saved $400,000 in lab charges during the 6-month intervention.
"Although the overall financial impact is modest, our study offers evidence that presenting providers with associated test fees as they order is a simple and unobtrusive way to alter behavior," the researchers concluded. "Unlike the process in previous studies, no extra steps were added to the ordering process and no large-scale educational efforts accompanied this exportable intervention."
The study was supported in part by the Johns Hopkins Hospitalist Scholars Program. The authors reported no relevant conflicts of interest.
