Health policy experts hope that technology will become a tool for educating doctors about the cost of care. More widespread use of electronic medical records, they say, will help keep costs in check by providing doctors with precise information on the price of tests and drugs even as they are deciding what to order.
According to a 1990 study by Indiana University researchers, showing the charges for tests on computers used by medical residents working in an outpatient clinic led to a 14 percent drop in the number of tests ordered, with no adverse effects on patients. Subsequent studies found similar results when the prices of tests and imaging studies were displayed on computers in pediatric emergency rooms and in a pediatric intensive care unit.
The research is not unanimous on this point. A pair of large randomized trials testing the approach in adult hospitalized medical and surgical patients at Brigham and Women's Hospital in Boston found no change in the ordering of X-rays when hospital charges were displayed on computers, and only a small reduction — not statistically significant — in blood tests.
Still, even that seemingly small change in doctors' test-ordering behavior translated into a $1.7 million annual saving in hospital charges for laboratory tests, said the study's senior author, Dr. David W. Bates, chief of general medicine at Brigham and Women's. Doctors "really liked seeing the cost information, so we've continued to display it" on hospital computers, he said.
He estimated that charges for tests were displayed for doctors and residents at fewer than 1 percent of the nation's teaching hospitals. Doctors prescribing drugs to patients at his hospital's clinics, and at others in Boston's Partners HealthCare System, also receive computerized prompts informing them of less-expensive alternatives, with suggestions tailored to each patient’s insurance coverage.
Dr. Bates said that students should begin learning early in medical school about the financial consequences of their decisions and that such teaching should continue throughout their training. When he supervises trainees in the hospital, he said, "I ask residents how much it costs to be in the I.C.U. for a day, to be in the hospital for a day, to be in a long-term-care setting for a day.
"Most of them have little, if any sense — and yet we're making decisions about that all the time, and they have huge implications."