Displaying Medicare fees in EHRs not associated with change in number of lab orders, study finds

When it comes to ordering inpatient lab tests, initiatives to introduce price transparency at the point of EHR entry may not change clinician behavior, according to a recent study published in JAMA.

Study authors — led by Mina Sedrak, MD, of Duarte, Calif.-based City of Hope Comprehensive Cancer Center — analyzed how displaying Medicare fee schedules for inpatient lab tests in EHRs affected clinician ordering behavior. The "Pragmatic Randomized Introduction of Cost data through the EHR" study consisted of a clinical trial at three Philadelphia hospitals between April 2014 and April 2016. Researchers randomly assigned 60 inpatient lab tests to one of two groups: one which displayed Medicare allowable fees in EHRs and one which did not.

In a sample of roughly 143,000 hospital admissions, study authors found no significant change in the number of lab tests ordered per patient day when comparing groups with Medicare fee schedule EHR displays to those without the addition. However, researchers did find a small change in ordering behavior in some subsets, such as an increase in labs ordered in the bottom fee quartile and a decrease in labs ordered in the top fee quartile, according to the study.  

"These findings suggest that price transparency alone may not lead to significant changes in clinician behavior," researchers concluded. They added "future price transparency interventions may need to be better targeted, framed or combined with other approaches," such as adjusting the display to each clinician scenario. 

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