Health Care Personnel Have Poor Understanding of Costs of ER Care Interview with:

Kevin Hoffman, DO Emergency medicine resident Lakeland Health in Saint Joseph, Michigan

Dr. Hoffman

Kevin Hoffman, DO
Emergency medicine resident
Lakeland Health in Saint Joseph, Michigan What is the background for this study?

Response: In this study, we researched emergency department providers’ understanding of the costs of care for three routine patient presentations. Our study differed from the majority of previous studies with the use of clinical vignettes and cost determination for the entire visit. This is in contrast to previous research which focused on cost assessment of individual tests or medications. We wanted to use a study design that was more realistic and applicable to the way we work in the emergency department (ED). The hope is that with this research based on clinical scenarios that the data will be more easily translated back into potential changes and ways to improve efficiency in the ED. What are the main findings?

Response: The data shows that we continue to have poor understanding of the costs of routine care in the ED. A very interesting piece of data which came through on analysis was the relationship between level of training and perceived level of understanding of costs. A trend emerged where those with higher levels of training (attending physicians with more experience) thought they understood costs well, however, their answers were no more correct than the other groups of participants. While our research was not tailored to look for this relationship, it was the most statistically significant correlation found. What I think this correlation shows is that cost education is not something that you can just pick up on the job or become knowledgeable about over a career. I think it is something that a provider does need to be taught if understanding is desired. What should readers take away from your report?

Response: Currently, healthcare providers have an inadequate understanding of the costs associated with the care we deliver in the emergency department. Studies have shown that when healthcare providers are informed on costs (for instance common lab tests) that cost can go down while maintaining high quality of care delivered. Our research data shows that experience does not correlate with cost understanding and if good understanding is desired, focused education will be required on this topic. The bills generated from emergency room visits have the potential to financially cripple a patient and it is not uncommon for those bills to be transferred to the taxpayer.

Medical decisions should never be made based only on the cost associated with them. However, when there is more than one way to effectively treat a patient, the more cost efficient choice should be chosen. I point to the use of intravenous medication verse oral medication. There are times when either the medication only comes in an IV form or when the IV form is more effective in terms of time to onset or bioavailability. When any difference does not affect the patient’s care this would be a good opportunity to choose a lower cost oral alternative compared to the IV form. What recommendations do you have for future research as a result of this study?

Response: We need a large, multicenter trial of the use of costs listed in the computerized physician order entry (CPOE) system to not only confirm that costs can be improved in a large scale trial, but also that high quality care and outcomes are preserved. Also, this research could be repeated at institutions which adopt listing costs in the CPOE to evaluate if this is effective at educating healthcare providers on cost. Is there anything else you would like to add?

Response: In medicine there are 4 main tenants of care which include beneficence (do what is right), non-maleficence (do no harm), justice (equal treatment), and autonomy (the patient is in charge of their healthcare decisions).

I think that cost of care can threaten the justice tenant by limiting the available resources to those who need them potentially limiting equality among patients. This is a very complicated idea with significant political, ethical, and financial considerations. This basic idea is what got me interested in this topic. I think that in order to develop rational approaches to improved efficiency we first need to understand our current situation in terms of the costs of care.

No disclosures. Thank you for your contribution to the community.


Kevin A. Hoffman, Michelino Mancini. Emergency Health Care Professionals’ Understanding of the Costs of Care in the Emergency Department. The Journal of the American Osteopathic Association, 2017; 117 (6): 359 DOI: 10.7556/jaoa.2017.073

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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