When Physicians See Costs, They Act Like Consumers

John Commins, for HealthLeaders Media , April 16, 2013

"Our ABO Blood Typing test was ordered 23,000 times in six months. The complete blood count was ordered 76,000 times," Feldman says. "They dwarf how many times these expensive tests are ordered by many, many orders of magnitude."

For example, once physicians were made aware that the price of a basic metabolic panel was about $3.08 cheaper per test than the $15.44 comprehensive metabolic panel, they began to order the cheaper tests and saved more than $27,000 over six months.

It's not just about saving money, Feldman says, noting that using more discretion when ordering tests can improve quality of care.

"There is not only a monetary cost. There are downstream costs when we order tests without a specific reason that can make the ordering of that test extremely costly," he says.

"If you order testing and for some reason it turned out to be abnormal when you didn't think it would that often leads to another test and another test and another test that may in no way benefit the patient. We need to keep all of this in mind when we are ordering tests. We have a responsibility to provide the high-value cost conscious care that this country needs to afford its healthcare system."  

Feldman concedes that there will be times when ordering several diagnostic blood tests at the same time is appropriate, even if some of the tests are later shown to be unnecessary, because it's less expensive to get a quicker diagnosis than it is to have patients run up hospital bills while waiting for answers.

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2 comments on "When Physicians See Costs, They Act Like Consumers"

Tubor Rathke (4/16/2013 at 1:26 PM)
The public has been bamboozled into believing that doctors order extra tests, driving up the cost of healthcare, because they fear malpractice lawsuits. Here is proof that doctors do extra testing because it's faster, more accurate, and easier than trying to diagnosis using a physical exam alone and that, when they don't have to worry about costs, they don't worry about costs.

flpoggio (4/16/2013 at 10:33 AM)
Nothing new here. This study has been done a thousand times. When I was the CFO at Univ of Wisconsin in 1977 we did this very same project, and got the same results. But here's what we learned afer six months. The test order volumes fall off for about three months, then the docs get conditioned to it, rationalize why the tests are necessary, and in about 6 months the volume is back where it was. One way they rationalize it is saying "hey, the patient isn't paying for it, the einsurance company is or Medicare, so it's little or no cost to the patient". The only real change that happens that sticks is when the doc has some skin in the game, ala Mayo (or ACO).




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