Primary Care: The Impact of Cost Displays on Laboratory Test Ordering Interview with: Thomas D. Sequist, MD, MPH, of Atrius Health Interview with:
Thomas D. Sequist, MD, MPH,
Atrius Health What are the main findings of the study?

Dr. Sequist: Our study, the Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering published in the Journal of General Internal Medicine found that when the costs of certain lab tests were displayed electronically in real time, the rate at which physicians ordered tests decreased. It was conducted among 215 primary care physicians working for Atrius Health, an alliance of six non-profit medical groups and a home health and hospice agency in Massachusetts, where an integrated electronic health record system is used.  Physicians in the intervention group received real-time information on laboratory costs for 27 individual tests when they placed their electronic orders, while the control group did not. What we found was a significant decrease in the ordering rates of both high and low cost range tests by physicians to whom the costs of the tests were displayed electronically in real-time. This included a decrease in ordering rates for four of the 21 lower cost laboratory tests, and one of six higher cost laboratory tests.

In addition, physicians were generally very receptive to the intervention. A majority (81 percent) reported that the exercise increased their knowledge regarding costs of care and requesting real-time cost information on an expanded set of health care services. Were any of the findings unexpected?

Dr. Sequist: We saw a statistically significant decrease in ordering rates for five tests, but what I found very interesting is that we actually saw a directional decrease in ordering rates for the majority of lab tests included in the study. While they were not all statistically significant and therefore, we didn’t include them in the final paper, it shows that the future implications are real.  We were also intrigued by the finding that nearly one-half of physicians reported that they did not have a firm understanding of costs of laboratory tests they routinely order. What should clinicians and patients take away from your report?

Dr. Sequist: Doctors tell us all the time that they don’t have a sense of what tests cost so our primary goal in showing these costs to providers was to educate them. We were trying to give them as much information as possible to help them practice value-based medicine and educate their patients as well. The study was about more than just costs, but also outcomes and value. With further research and testing, these findings show patients tangible results that you can receive quality care at lower costs. What recommendations do you have for future research as a result of this study?

Dr. Sequist:

There are two issues we should focus on for future research. First, we need to look at how the reduction in utilization of procedures and tests impacts quality of care.  We want to make sure that we are only cutting back on low value services of limited benefit to patients and that high value services continue to be delivered. Second, we should look at whether displaying costs is an effective strategy for more expensive items like operations and imaging.


The Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering
J Gen Intern Med. 2013 Nov 21. [Epub ahead of print]
The Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering.
Horn DM, Koplan KE, Senese MD, Orav EJ, Sequist TD.
Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA