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18-04-2013 | Internal medicine | Article

Cost awareness fosters prudent test ordering


Free abstract

medwireNews: A modest decrease in laboratory test ordering occurs when fee data are presented to providers, a study finds.

The modification could lead to more efficient, cost-conscious use of limited healthcare resources, say the authors in JAMA Internal Medicine.

"Simply displaying the Medicare allowable fee of diagnostic laboratory tests at the time of order entry can affect physician ordering behavior, even without any additional educational interventions," write Leonard Feldman (Johns Hopkins University, Baltimore, Maryland) and colleagues.

Felman and team assessed data from The Johns Hopkins Hospital for orders of 61 different laboratory tests conducted during a 6-month baseline period (November 2008 to May 2009) when fee information was not displayed to providers.

A subsequent assessment was done after a 6-month intervention exactly 1 year later, when half the tests requested through the computerized provider order entry (cPOE) system were randomly assigned to have fees marked (30 active tests) and half did not (31 control tests).

A 9.1% reduction in the number of orders occurred during the intervention period compared with the baseline period. The number of tests per patient also decreased, from an average of 3.7 to 3.4, an 8.6% drop.

Conversely, there was a 5.1% increase from baseline in orders for control tests, caused by a 5.6% increase in the number of control tests per patient, from 1.15 to 1.22.

The difference between active and control tests with regard to change in order frequency was significant.

Additionally, the active arm had a US$ 3.79 (€ 2.90, 9.6%) decrease per patient-day while control tests increased by US$ 0.52 (€ 0.40, 2.94%) per patient-day. This translated to a net hospital-wide charge decrease of US$ 436,115 (€ 338,860) during the 6-month intervention period.

"In all, 7 of the diagnostic tests in the active arm and none on the control arm exhibited a total charge decrease of more than $25,000 [€ 19,141] between the intervention and baseline periods," the authors observe.

"Whether broadening this intervention and coupling it with educational interventions related to cost consciousness and stewardship of resources will increase its effect on clinical practice deserves further study, provided that providers are not inappropriately incentivized to limit needed care" they conclude.

In an accompanying editorial, William Tierney (Indiana University, Indianapolis, USA) acknowledges the complexity of physician motives on ordering laboratory tests.

Nevertheless, he points out that electronic health records and computer-based decision support "will never eliminate the costs associated with unnecessary testing, but they can help in dealing with larger health system and cultural issues."

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Peter Sergo, medwireNews Reporter

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