According to previous research, physicians acknowledge that it is important to be aware of the costs associated with care they provide to ensure the delivery of high-quality care. However, many physicians—including those in emergency medicine—admit that their knowledge of costs is deficient. The ability of ED physicians to make cost-effective decisions may be limited by their education and understanding of healthcare costs. This phenomenon persists despite recent efforts to modify cost knowledge for physicians.
Surveying the Scene
For a study published in the American Journal of Emergency Medicine, Camille Broadwater-Hollifield, PhD, MPH, and colleagues investigated physician knowledge of costs for common tests and procedures ordered in the ED. “We wanted to determine their relative accuracy in estimating costs and find out the impact of perceived costs on ordering and prescribing behaviors,” says Dr. Broadwater-Hollifield. “This data may help us develop targeted educational programs for emergency physicians to ensure that they deliver high-quality, high-value care in the ED.”
The investigators distributed an online survey to emergency physicians in 11 different EDs. The survey asked respondents to estimate reimbursement rates for a set of medical tests and procedures, rate their level of current cost knowledge, and determine the effect of assumed medical costs on their medical decision-making. Of the 97 respondents to the survey, 65% perceived their knowledge of costs to be inadequate. Nearly 40% indicated that their beliefs about cost impacted their ordering behavior.
The research team also found that about 80% of physicians surveyed were unable to estimate 25% of costs within a ±25% range, and no physicians estimated at least 50% of costs within ±25% of CMS reimbursement. Only 17% of medical services were estimated correctly within ±25% by one or more physicians who responded to the survey. “Our data show that the disconnect between costs and knowledge of these costs from emergency physicians is large,” Dr. Broadwater-Hollifield says. “There is also wide variation in cost estimations when compared with actual values.”
Considering the Implications
Dr. Broadwater-Hollifield notes that it is unclear if providing ED physicians with cost information will decrease test ordering if they already overestimate the costs of specific tests or procedures. She adds that it is possible that providing physicians with variable cost information about individual tests and procedures may increase the likelihood that they ordering tests that are less expensive without regard for the cumulative impact it may have on patient charges.
To meet the challenges of providing sustainable value-based healthcare, Dr. Broadwater-Hollifield and colleagues encourage emergency physicians to gain more training in medical economics. Several modalities have been proposed in clinical research to educate physicians on this topic, including interactive didactic sessions, individual feedback, and audits.
“There are some simple actions to consider, such as posting pricing lists within an institution or integrating cost reminders into computerized clinical support tools,” Dr. Broadwater-Hollifield says. “By making this information transparent, we may be able to increase physician awareness of costs and decrease unnecessary test ordering and admissions. The key is to ensure that these interventions are easily accessible and applicable to the ED setting.”
Readings & Resources (click to view)
Broadwater-Hollifield C, Gren LH, Porucznik CA, Youngquist ST, Sundwall DN, Madsen TE. Emergency physician knowledge of reimbursement rates associated with emergency medical care. Am J Emerg Med. 2014;32:498-506. Available at: http://www.ajemjournal.com/article/S0735-6757(14)00076-X/abstract.
Caldwell N, Srebotnjak T, Wang T, Hsia R. “How much will I get charged for this?” Patient charges for top ten diagnoses in the emergency department. PLoS One. 2013;8:e55491.
Rosenbaum L, Lamas D. Cents and sensitivity—teaching physicians to think about costs. N Engl J Med. 2012;367:99-101.
Innes G, Grafstein E, McGrogan J. Do emergency physicians know the costs of medical care? CJEM. 2000;2:95-102.