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Hospital Lab Testing Volume Unaffected by Making Pricing Transparent, Study Finds

NEW YORK (360Dx) – Displaying Medicare fees for inpatient laboratory services in electronic health record systems may not yield "significant" changes in the number of tests clinicians order, according to the results of a study published online today in the journal JAMA Internal Medicine.

The conclusions are from a year-long clinical trial conducted at three University of Pennsylvania Health System hospitals — Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, and Pennsylvania Hospital — that included more than 98,500 patients and nearly 143,000 hospital admissions.

The trial team posted Medicare reimbursements for tests in a shared electronic health record. They hypothesized that over time, displaying the reimbursement information could yield a significant reduction in the number of tests ordered by clinicians and reduce associated fees.

Proponents believe that this type of approach could help mitigate rising costs in US healthcare. As a result, some health systems are considering increasing price transparency. 

Earlier research suggested that the posting of prices was well-received by physicians and could yield a modest decrease in test ordering, and reduce the number of "inappropriately ordered diagnostic tests."

The UPenn team took on the trial because they believed there was limited evidence of the impact of posting pricing. Findings, they said, are inconsistent and limited to "shorter duration" single-site evaluations.

In the study, the researchers said that the primary goal of the study was to measure the number of tests order per patient-day. The secondary goal was to measure the number of tests performed per patient-day and associated fees per patient-day.

During the period they looked at before the Medicare pricing information was included in patient EHRs, the mean number of tests order per patient-day was 2.31 in a control group and 3.93 in an intervention group.

During the period when the pricing information was included in EHRs, the mean number of tests ordered per patient-day ticked up only slightly to 2.34 in the control group and to 4.01 in an intervention group.

Meanwhile, during the preintervention period, the mean associated fees per patient-day was $27.77 in the control group and $37.84 in the intervention group. During the intervention period, the mean associated fee per patient-day was $27.59 in the control group and $38.85 in the intervention group.

Based on their findings, the researchers concluded that "price transparency alone may not lead to significant changes in clinician behavior, and future price transparency interventions may need to be better targeted, framed, or combined with other approaches."

They noted that they did find "small but significant overall changes" in tests performed but not in test ordered, though they said it is unclear whether the differences were due to price transparency.

The University of Pennsylvania Health System funded the study.