New Study: Including Costs in Electronic Health Records Doesn’t Change Physician Behavior
May 1, 2017
| by Letisia Marquez
Mina Sedrak, M.D.
aimed at determining whether hospitals could reduce ordering of unnecessary lab tests by displaying Medicare fees determined that price transparency does not appear to impact test orders. City of Hope’s Mina Sedrak, M.D.
, led the study.
It’s estimated that about a third of laboratory tests ordered for patients who are hospitalized are unnecessary. Excessive blood draws increase patient discomfort from unwarranted needle sticks and can even lead to patient harm from hospital-acquired anemia and false positive results that lead to more testing, more procedures, and longer hospital stays.
“There is a growing call for physicians to factor financial consequences into their medical decisions, but there is limited data on the impact of price transparency on low-value services such as inpatient lab ordering practices. This is the first multi-site, randomized controlled clinical trial to study this question and the largest of its kind,” said Sedrak, assistant professor and breast cancer oncologist in City of Hope’s Department of Medical Oncology & Therapeutics Research
. He conducted the study as a fellow at the Perelman School of Medicine at the University of Pennsylvania.
“Our findings indicate that price transparency alone was not enough to reduce the rates of test ordering and increase cost-savings,” he added. “Future price transparency interventions may need to be better targeted, framed or combined with other approaches to be more successful.”
Sedrak and his team randomly assigned 60 groups of inpatient laboratory tests to either display Medicare allowable fees in the patient’s electronic health record (intervention arm), or not (control arm). The randomized clinical trial was conducted at three hospitals in Philadelphia over a one-year period and compared changes in the number of tests ordered per patient per day, and associated fees, for more than 98,000 patients (totaling over 142,000 admissions).
Results of the study, which was published today in JAMA Internal Medicine, showed that there was no significant change in the average number of tests and associated fees ordered per patient per day when cost information was displayed.
“Though the study found no overall effect,” Sedrak said, “we noted a few important findings in specific patient groups.”
For example, there was a slight decrease in test ordering for patients admitted to the Intensive Care Unit. The most expensive tests were ordered less and the cheaper tests were ordered more. This suggests that future interventions might be more successful if they are targeted to certain patient populations or clinical settings and better designed to frame relative pricing.
“The results of this clinical trial indicate that price transparency approaches need to be better designed to effectively change behavior,” Sedrak said. “As more and more hospitals move to using the electronic health records (EHR), the majority of decisions doctors make about their patients are now through the EHR. We need to spend more time in thinking about how EHR is designed in order to better leverage this technology to improve the way care is delivered for our patients.”
Up next for Sedrak is a SWOG career development award project titled, “Mixed Methods Assessment of Social Media Use among SWOG Researchers.” The goal of the work is to better understand how SWOG researchers who conduct, design and enroll patients in cancer clinical trials use social media.
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