Healthcare consumers who are unaware of the varying costs of routine medical tests may take solace in knowing that many physicians don't either.
"Doctors have been shielded from costs for generations," says Leonard S. Feldman, MD, an assistant professor of medicine at the Johns Hopkins University School of Medicine.
"As these systems were developing people thought it was inappropriate to expose the physicians to while they were making decisions about care. Most physicians have no idea what the costs are for whatever they're prescribing. We have never really certainly competed with one another on a regular basis based on price."
Feldman says hospitals keep patients and doctors in the dark on the cost of medical services, which contributes to the soaring cost of healthcare in the United States. With those costs poised to consume about 20% of the national economy, Feldman doctors will have to become more cost savvy.
"At this juncture in society and the world we live in, we can't afford that luxury anymore of taking into consideration these important issues," he says.
Feldman is the lead author of a new online study published this week in JAMA Internal Medicine that found that when doctors are told the price of some diagnostic laboratory test as the tests are ordered, they respond like informed consumers and either order fewer tests or shop around for cheaper alternatives.
"One of the best ways to make sure we are doing the best by our patients is to order the tests that actually needs to be ordered for that patient and to remember that there is a cost to every test that we order," Feldman says.
The Johns Hopkins study identified 62 diagnostic blood tests frequently ordered for patients at The Johns Hopkins Hospital. Researchers divided the tests into two groups and made sure prices were attached to one group from November 2009 to May 2010 at the time doctors ordered the lab tests.
They left out the pricing information for the other group over the same time period. When the researchers compared ordering rates to a six-month period a year earlier when no costs were displayed, they found a nearly 9% reduction in tests when the cost was revealed as well as a 6% increase in tests when no price was given. The net charge reduction was more than $400,000 over six months.
Researchers were surprised to find that the biggest savings came when doctors changed ordering patterns for basic and relatively inexpensive tests that are ordered thousands of times, rather than from costlier tests.
"We thought if we were able to decrease these expensive tests we will make a difference," Feldman says. "It turns out that those expensive tests aren't ordered often enough that decreasing the number ordered by a good percentage… doesn't actually save money."
"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.
Feldman says he believes that the cost savings found in his study could be replicated at other hospitals.
"If I were a CEO that had a provider order entry system that allowed me to easily show these costs I would certainly start showing the cost of a lot of our relatively inexpensive but frequently ordered tests. You are better off if you are reminded of it right when you need it. That was part of the power," he says.
"There are lots of studies out there where people have gone on with big educational efforts and the problem is they require a lot of effort from the faculty and they are quickly forgotten if they're not brought up on a regular basis," he says. "The beauty of ours was that it was a very cost-effective way of providing this information on a continual basis."
At the same time, Feldman says physicians do not need to be aware of the cost of every test or professional service they provide.
"I am worried about people getting cost overload," he says. "But for the tests that I know that my docs are ordering every day and maybe on a repeat basis… if I had the opportunity that would be where I would try to make the biggest impact."
John Commins is the news editor for HealthLeaders.