Doctor's Choices Influenced by Lab Test Cost

When doctors know what hospitals charge for certain lab tests, they order far fewer of them or look for cheaper alternatives.

Investigators discovered that currently hospitals generally do not disclose the price of lab tests to doctors and this contributes to the high cost of health care in the US.

A six-month study looked at the use of 62 diagnostic blood tests frequently ordered for patients at the Johns Hopkins Hospital (Baltimore, MD, USA) Doctors in one group were given the cost of each of the tests while doctors in another group were not provided with that information.

The group of doctors who knew the prices ordered nearly 9% fewer lab tests, which saved more than USD 400,000 over the study period, according to the study appearing April 15, 2013, in the journal JAMA Internal Medicine. There was a 6% increase in the number of tests ordered by the group of doctors who did not know the prices.

"We generally don't make decisions based on what is cost-effective or what is known to be absolutely necessary for our patients, but knowing the cost of things appears to make us more thoughtful about what we think might be best for their health," study leader Dr. Leonard Feldman, an assistant professor of medicine at Johns Hopkins, said in a hospital news release. He added, "There's a lot of waste in medicine because we don't have a sense of the costs of much of what we do."

Feldman said the findings offer "evidence that presenting providers with associated test fees as they order is a simple and unobtrusive way to alter behavior. In the end, we ordered fewer tests, saved money, and saved patients from extra needle sticks without any negative outcomes."

Many of the savings seen in the study were the result of comparison-shopping. For example, it cost USD 15.44 for a comprehensive metabolic panel, a blood test that checks fluid and electrolyte status, kidney and liver function, blood sugar levels, and response to various medications. A basic metabolic panel checks many of the same things but costs USD 3.08.

During the six-month study, the number of comprehensive metabolic panel tests ordered by doctors who knew the price fell by about 8,900, while the number of basic metabolic panels grew by about the same number. That shift alone saved more than USD 27,000 over the study period, the scientists said.

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