Cost transparency doesn't impact use of imaging tests

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Revealing the costs of expensive imaging tests in advance--transparent pricing--has no effect on the number of tests physicians order for their patients, according to a study published online this month in the Journal of the American College of Radiology.

While some studies have shown, for example, that doctors might order fewer laboratory tests when given the price up front, imaging tests seem to be a "different animal," according to senior study author, Daniel Brotman, M.D., an associate professor of medicine at the Johns Hopkins University School of Medicine.

For the study, Brotman and his colleagues identified the 10 most frequently ordered imaging tests for patients, assigning five to a control group (ultrasound extremity, posteroanterior and lateral chest X-ray, CT abdomen with contrast, CT chest with contrast and abdominal ultrasound) and five to an active cost display group (head CT, renal and vascular ultrasound, and anteroposterior chest and abdominal X-rays).

Then, over a six-month period from November 2009 to May 2010, imaging test costs were detached from the control group, but were given to other group. The researchers found that during the six-month period there was no significant change in ordering rates compared to the six-month period in the preceding year when no costs were displayed at all.

"Cost alone does not seem to be the determining factor in deciding to go ahead with an expensive radiographic test," Brotman said in an announcement. "There is definitely an over-ordering of tests in this country, and we can make better decisions about whether our patients truly need each test we order for them. But when it comes to big-ticket tests like MRI, it appears the doctors have already decided they need to know the information, regardless of the cost of the test."

Brotman said that while price transparency didn't influence the way physicians order tests in his study, financial considerations could play a role if tied to clinical evidence in other circumstances. He pointed out that when programs compared the amount of blood products used by surgeons, those who used more than their colleagues--but with the same clinical results--began to reduce their reliance on transfusions. Brotman suggested that showing a physician that his colleagues are getting similar clinical results even though they are ordering fewer CT scans could be beneficial when it comes to ordering tests.

"Cost transparency must be part of the solution to solving fiscal challenges in medicine," Brotman said. "Providers have no idea how much they're spending. Patients don't know either. Having everyone understand more of the economics of health care is a great place to start cutting costs in medicine."

For more:
- see the study abstract
- read the announcement

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