Posted: January 28, 2013
Telling doctors how much a CT scan of the head would cost didn't have an effect on the number of scans ordered during a study at a big teaching hospital. It will take more than disclosing costs to control spending on radiology costs, a study suggests.
If doctors would just pay attention to how much things cost, they might be more careful when ordering tests for patients, right?
Well, that's the theory behind some research and projects to cut wasteful health spending. But a study at Johns Hopkins Hospital found that changing doctors' behavior may be not be as easy as simply making them aware of prices.
Radiologist and hospitalists collaborated on an experiment to see if disclosing the cost of some of the most frequently ordered imaging tests, including standard chest X-rays and CT scans of the head, would reduce their use in the hospital.
The short answer is no.
Telling doctors that a head CT would cost $229.95, for instance, didn't do much to affect the number of scans done during a six-month period when its price was revealed compared with a similar period when the price wasn't displayed on computerized ordering screens.
In the experiment, researchers disclosed the prices of five of the most frequently ordered tests and withheld the prices of five others for a period of six months.
They compared doctors' orders for both groups of tests. There was no meaningful difference between them. The findings were published online by the Journal of the American College of Radiology.
So does this mean don't bother?
"Just because cost transparency didn't work for radiographic tests doesn't mean it won't work for other diagnostic tests," said Dr. Daniel Brotman, head of the hospitalist program at Johns Hopkins and a co-author of the study. "It's important not to reach the general conclusion that cost transparency doesn't influence provider behavior."
Previous research that Brotman was involved with found that revealing prices of lab tests could make a difference. Many of those tests get ordered almost automatically without a doctor thinking very much about whether they're really necessary. Radiology tests, particularly those ordered in a teaching hospital as was the case in this study, are usually ordered with a specific reason in mind.
"When you have inpatient diagnostics being ordered by a team of physicians, the decision-making might be a little more diffuse than in other situations," he says. An attending physician might make the key decision while an intern is the one actually at the screen ordering the test — and seeing the price.
For imaging tests, he says, guidelines summarizing the medical evidence can help more than knowing the tab.
It's common knowledge there are too many MRIs ordered for back pain, he says. Most patients will get better with time. "Almost the only reason to get an MRI is because you think you might need surgery," he says.
Brotman says he would like to move beyond cost and give individual doctors information about where they stand relative to their peers in ordering various tests.
"There is so much variability in how physicians practice," he says. "One of the most important things we can do is shine a light on that and let people do self-assessments and group assessments on how they use resources."
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