Impact of Cost Display on Ordering Patterns for Hospital Laboratory and Imaging Services

Abstract

Background: Physicians “purchase” many health care services on behalf of patients yet remain largely unaware of the costs of these services. Electronic health record (EHR) cost displays may facilitate cost-conscious ordering of health services. Objective: To determine whether displaying hospital lab and imaging order costs is associated with changes in the number and costs of orders placed. Design: Quasi-experimental study. Participants: All patients with inpatient or observation encounters across a multi-site health system from April 2013 to October 2015. Intervention: Display of order costs, based on Medicare fee schedules, in the EHR for 1032 lab tests and 1329 imaging tests. Main Measures: Outcomes for both lab and imaging orders were (1) whether an order was placed during a hospital encounter, (2) whether an order was placed on a given patient-day, (3) number of orders placed per patient-day, and (4) cost of orders placed per patient-day. Key Results: During the lab and imaging study periods, there were 248,214 and 258,267 encounters, respectively. Cost display implementation was associated with a decreased odds of any lab or imaging being ordered during the encounter (lab adjusted odds ratio [AOR] = 0.97, p =.01; imaging AOR = 0.97, p