A study by Leonard S. Feldman, M.D., and colleagues at The Johns Hopkins University School of Medicine, Baltimore, examined if the number of laboratory tests ordered could be reduced by presenting clinicians with test fees at the time of order entry, without adding extra steps to the ordering process. (Online First)
All clinicians, including physicians and nonphysicians, who ordered laboratory tests through the computerized order entry system at The Johns Hopkins Hospital were included in the study. Researchers randomly assigned 61 diagnostic laboratory tests to an “active” group (fee displayed) or to a “control” group (fee not displayed). No fee was displayed during a 6-month baseline period (November 2008 to May 2009). During a 6-month intervention period 1 year later (November 2009 to May 2010) fee data were displayed, based on the Medicare allowable fee, for active tests only.
According to study results, for the “active” group, rates of test ordering were reduced from 3.72 tests per patient-day in the baseline period to 3.40 tests per patient-day in the intervention period (8.59 percent decrease). For the “control” group, ordering increased from 1.15 to 1.22 tests per patient-day from the baseline period to the intervention period (5.64 percent increase).
“Presenting fee data to providers at the time of order entry resulted in a modest decrease in test ordering. Adoption of this intervention may reduce the number of inappropriately ordered diagnostic tests,” the study concludes.
(JAMA Intern Med. Published online April 15, 2013. doi:10.1001/jamainternmed.2013.232.