Clinical question: Does price transparency of laboratory tests at the point of order entry affect provider ordering behavior?
Background: Up to 30% of laboratory testing may be unnecessary, and health systems are seeking ways to effectively influence provider ordering of tests to reduce costs and improve value to patients. Price transparency and cost displaying is one strategy that has had mixed results in influencing provider ordering and reducing the amount of unnecessary laboratory testing.
Study design: Randomized clinical trial.
Setting: Three urban academic hospitals in Philadelphia.
Synopsis: Sixty inpatient laboratory tests were randomized to either display Medicare fees at the point of order entry or not. Changes in outcomes were followed for 1 year preintervention and 1 year post intervention. The population included 98,529 patients comprising 142,921 hospital admissions. Tests ordered per patient-day and Medicare-associated fees did not significantly change in the intervention group or the control group in the year after the intervention, compared to the year preintervention.
Bottom line: Displaying laboratory testing fees at the point of order entry did not lead to a significant change in provider ordering behavior or reduction in costs.
Citation: Sedrak MS, Myers JS, Small DS, et al. Effect of a price transparency intervention in the electronic health record on clinician ordering of inpatient laboratory tests: The PRICE randomized clinical trial. JAMA Intern Med. 2017 Jul 1;177(7):939-45.
Dr. Chung is hospitalist and assistant professor of medicine, Icahn School of Medicine of the Mount Sinai Health System.