The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

Abstract

BACKGROUND: While studies have been published in the last 30 years that examine the effect of charge display during physician decision-making, no analysis or synthesis of these studies has been conducted. OBJECTIVE: We aimed to determine the type and quality of charge display studies that have been published; to synthe-size this information in the form of a literature review. METHODS: English-language articles published between 1982 and 2013 were identified using MEDLINE, Web of Knowledge, ABI-Inform, and Academic Search Premier. Article titles, abstracts, and text were reviewed for relevancy by two authors. Data were then extracted and subsequently synthesized and analyzed. RESULTS: Seventeen articles were identified that fell into two topic categories: the effect of charge display on radiology and laboratory test ordering versus on medication choice. Seven articles were randomized controlled trials, eight were pre-intervention vs. post-intervention studies, and two interventions had a concurrent control and intervention groups, but were not randomized. Twelve studies were conducted in a clinical environment, whereas five were survey studies. Of the nine clinically based interventions that examined test ordering, seven had statistically significant reductions in cost and/or the number of tests ordered. Two of the three clinical studies looking at medication expenditures found significant reductions in cost. In the survey studies, physicians consistently chose fewer tests or lower cost options in the theoretical scenarios presented. CONCLUSIONS: In the majority of studies, charge information changed ordering and prescribing behavior.KEY WORDS: charge display; physician behavior; costs of care.

Costs and stewardship of laboratory tests in the Capital Health District

“…Previous research has shown cost savings among clinicians exposed to diagnostic pricing data compared to control groups, [11][12][13][14] and in all clinical cases studied with data available, this did not affect patient outcomes or satisfaction. 13 However, the availability of outcome data remains quite limited overall.…”

“…13 However, the availability of outcome data remains quite limited overall. 11 Interestingly, in three of six clinical and simulated studies involving pricing education, the observed cost savings did not necessarily arise from reduced testing overall, but rather from substitutions.…”

“…11 Interestingly, in three of six clinical and simulated studies involving pricing education, the observed cost savings did not necessarily arise from reduced testing overall, but rather from substitutions. 13 Physicians have also shown enthusiasm for learning more about the costs of their orders. 12 With this information in mind, the goal of this study is to contribute to greater bottom-up resource control among Capital Health clinicians.…”

Capsule Commentary on Goetz et al., The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

“…The significance of the study by Goetz et al (2015) would have been further enhanced had the authors 1 included the economic literature on payment mechanisms and provider behaviors. [2][3][4][5] In addition, an assessment of the quality of studies included in the review would be helpful for explaining the implications of the different methodological designs used (Cross-sectional, Cohort, Case-control studies).…”

Capsule Commentary on Schiavoni et al., How Primary Care Physicians Integrate Price Information into Clinical Decision Making

“…Goetz et al 2 identified 17 articles analyzing the effect of displayed charges for both laboratory and radiology orders as well as medication choice; they concluded that charge information changed ordering and prescribing practices. These results are consistent with those found by Horn et.…”