Displaying the Price of Tests Makes Docs Think Twice

By Scott Harris

During any shopping trip, an item found without a price tag seems to be followed inevitably by the old quip that “if there’s no price, it must be free.”

The joke’s ubiquity might speak to an inherently human tendency to simply ignore the cost if it’s not clearly marked—and you’re not the one shelling out. That even appears to apply to health care.

A study conducted by researchers at The Johns Hopkins University School of Medicine and published online April 15 by JAMA Internal Medicine showed that simply displaying the cost of a procedure lowered the rate of test ordering by 9 percent, with no evidence of a corresponding decline in the quality of the care delivered.

“We looked at the number of labs Hopkins had been ordering and we thought to ourselves it seems we’re ordering a lot more labs than needed to care for patients in a safe and high-quality way,” said lead study author Leonard S. Feldman, M.D., an assistant professor of medicine in the school’s Division of General Internal Medicine. “You could order any lab you wanted without any sense of cost to it. It’s like a bottomless cup that you just continue to fill with more and more labs. There are more tests available to us. They come back faster, and others do it for them. It’s almost too easy.”

Over a six-month period, the researchers randomly assigned 61 diagnostic laboratory tests at The Johns Hopkins Hospital for the experiment, displaying fee data for some tests but not for others. The 9 percent occurred for the tests displaying fee data, while those that did not have fee data displayed increased slightly. The research saved the hospital $400,000 over six months.

Feldman said the experiment also reduced costs without placing any new burdens on providers.

“We just reminded them of the costs without adding extra clicks or making their job harder or doing a large educational effort where the gains can go away,” Feldman said. “It reminds providers that there is a cost to doing business, and they should take that into account.”

Feldman said the most savings occurred in the more common tests. In one of the more extreme examples, Feldman said there was “a huge reduction” in orders for ionized calcium tests, which Feldman said were being ordered in many cases “for no reason we could readily ascertain.”

Feldman said the fee data display was becoming a more regular feature at the hospital. Because Hopkins is a teaching hospital, residents are often the ones ordering the tests. Previous studies have shown that younger doctors tend to order more tests than their older counterparts.

“It’s almost too easy these days to order a test. You order it and someone else does it for you. Ordering tests is what we do,” Feldman said. “But residents here are saying it was neat to see the cost. They were open to it and pleased.”

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