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Displaying Lab Costs Upfront Could Save Money

Study shows benefit of including real-time costs of lab tests in EHR system (November 21)

Health care costs continue to go up, and physicians control more than 80% of those costs. Could providing physicians with real-time information about the cost of what they order help to restrain excessive testing? This question is addressed in an article in the Journal of General Internal Medicine. The research project was among the first to focus on the effect that the passive display of real-time laboratory costs can have in a primary care, nonacademic setting.

The study was conducted among 215 primary care physicians working in Atrius Health, an alliance of six nonprofit medical groups, and a home health and hospice agency in Massachusetts, where an integrated electronic health record (EHR) system is used. Physicians in the intervention group received real-time information on laboratory costs for 27 individual tests when they placed their electronic orders, whereas the control group did not. Changes in the monthly laboratory ordering rate between the intervention and control groups were compared for 12 months before and 6 months after the intervention started. Six months after the intervention, all physicians taking part in the study were also asked to assess their attitudes regarding costs and cost displays.

The researchers found a significant decrease in the ordering rates of both high-cost and low-cost tests by physicians to whom the costs of the tests were displayed electronically in real time. This included a significant relative decrease in ordering rates for four of 21 lower-cost laboratory tests and for one of six higher-cost laboratory tests. In addition, physicians were generally receptive to the intervention. Most of them (81%) reported that the exercise increased their knowledge regarding costs of care and requests for real-time cost information on an expanded set of health care services.

“Our study demonstrates that electronic health records can serve as a tool to promote cost transparency, educate physicians, and reduce the use of potentially unnecessary laboratory tests by integrating the relative cost of care into providers’ decision-making processes,” said senior author Thomas D. Sequist, MD, MPH.

Source: Springer; November 21, 2013.

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