EMBARGOED FOR MAY 3, 1999
CONTACT: Kathleen Keenan, (773) 880-4500
INDUSTRY-IMPACTING STUDY DRAWS CORRELATION BETWEEN PRICE INFORMATION, PHYSICIAN TEST ORDERING AND PATIENT
In the on-going battle between managed care and physicians, the burden lies on physicians to practice more efficiently. A study presented at the 1999 Society for Pediatric Research Annual Meeting, San Francisco, CA, May 3, 1999, and published in the April, 1999 inaugural issue of The Journal of the Ambulatory Pediatric Association, draws an industry-illuminating conclusion. The study, conducted in an urban, university-affiliated Pediatric Emergency Department, was undertaken by Louis C. Hampers, MD, MBA, Susie Cha, BA, David J. Gutglass, MD, Steven E. Krug, MD, and Helen J. Binns, MD, MPH, Pediatric Emergency Medicine, Children's Memorial Hospital, Chicago, IL. The premise held that physicians who had information regarding hospital charges for diagnostic studies had been shown to decrease resource utilization in some settings. The study sought to determine if such information would affect test ordering and quality of patient care in an academic pediatric emergency department (ED), a place where physicians in training have no direct incentives to reduce costs. "I believe the public would prefer that doctors, rather than administrators, determine the most cost-effective way to evaluate patients," says Louis C. Hampers, MD, one of the physicians who headed the study and who presented the results at the Society for Pediatric Research Annual Meeting. "If we don't know the relative prices for the tests we order, how can we have an objective dialogue with the HMO regarding decisions that are made affecting our daily practice?" The study spanned ED visits from 9/97-12/97 (control), 1/98-3/98 (study) and 3/98-4/98 (washout). Patients ranged in age from two months to 10 years and were not chronically ill. In the control period, physicians checked tests ordered from a list attached to each patient chart. In the study period, physicians totaled the price from a list which included the standard hospital charges for each test. In the washout period, the control forms were used again. In the control and study periods, seven days following the visit, families of non-admitted patients were interviewed by telephone. When adjusted for triage level, vital signs and admission rates, in a multivariate model, charges for tests in the study period were 27% less than in the control period. The greatest decrease was seen among low acuity, non-admitted patients (43%). Two thousand forty nine patient families were contacted for follow-up seven days post visit. Patients in the study period were more likely to have made an unscheduled follow-up visit to a health care provider (24% vs. 18%), but did not differ on improved condition (87% vs. 83%) or family satisfaction (94% vs. 93%). Adjusted charges in the washout period were 15% lower than the control period and 15% higher than the study period.
The conclusion showed that providing price information significantly reduced charges for tests ordered on pediatric ED patients with acute illness not requiring admission. This decrease was associated with a slightly higher rate of unscheduled follow-up, but no difference in overall outcomes or family satisfaction. The study finds that trainees are sensitive to price information if it is provided to them, and that they are able to use this in a way that lowers cost without risk to their patients. "Trainees and doctors in an academic setting often have no knowledge of cost related to tests ordered," reports Dr. Hampers. "If we are to adequately prepare trainees for their future in a managed care, HMO-dominated world, it is critical that they have a knowledge of the same information that HMOs are using."
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During the meeting, please call the Moscone Convention Center press room at 415-905-1001 to speak with researchers or [email protected].
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