Cost Transparency doesn’t reduce testing…

February 11, 2013


Would physicians order less tests if they knew the cost?  Researchers in the Department of Radiology at John’s Hopkins say no.  This month’s issue of the Journal of  American College of Radiology includes a study on the subject:

Durand DJ, Feldman LS, Lewin JS, Brotman DJ.  Provider cost transparency alone has no impact on inpatient imaging utilization.  J Am Coll Rad. 2013 Feb;10(2):108-13 PMID:  23273974

Quick Summary:

The study used retrospective data to identify 10 of the most-utilized radiology tests in their institution.  During a baseline period they measured imaging utilization in a control and an active group.  During the intervention period (which was seasonally matched) they showed the cost of imaging to the active group prior to test utilization.  They measured a mean utilization change between groups and found that there was no statistically significant difference between groups.  They concluded that showing physicians the cost of the test doesn’t dissuade them from utilizing the imaging.

My Thoughts (not to be taken as the expert opinion!):

This is an interesting article that can lead some to believe that physicians don’t care about the cost of imaging.  It strikes a subject that is very “sexy” in the news due to the ever-rising cost of healthcare.  It is no mystery that imaging utilization is increasing on a yearly-basis and at some point the cost to society may outweigh the benefit.  However, in today’s litigious society physicians aren’t willing to risk misses and not utilize imaging capability that is literally in the next room.  I unfortunately don’t have a solution.  However, this article suggests that putting a price tag in front of us is not the answer.

Perhaps the regulatory control agencies can solve the problem (I just chuckled a bit).  In 2012, Centers for Medicare and Medicaid Services (CMS) decided to run a “dry run” measure of ED Head CT usage in non-traumatic headache.  I haven’t heard of the results yet, has anyone else?

Author:  Russell Jones, MD

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EMREMS: Radiology in Emergency Medicine

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