Physician Behavior Not Changed by EHR Price Transparency, Study Finds

A new study published in JAMA Internal Medicine finds that adding Medicare fee schedules to hospitals’ electronic health record (EHR) systems did not significantly impact the number of laboratory tests ordered by physicians.

Researchers conducted the Pragmatic Randomized Introduction of Cost data through the Electronic health record (PRICE) trial at 3 hospitals in Philadelphia. The trial compared the rates of laboratory test ordering before and after the intervention for 30 test groups in the control group and 30 in the intervention group.

When a clinician searched in the EHR for a test in one of the intervention test groups, the results included price transparency information. Specifically, it displayed the Medicare allowable fee for each test and a message explaining that it represented the amount Medicare would reimburse.

When comparing physician ordering behavior for the intervention and control groups in terms of tests ordered per patient-day, the researchers found no significant overall change. However, there were some small changes detected in some subsets, like an increase in ordering tests in the bottom fee quartile and a decrease in ordering tests in the top fee quartile. Likewise, there was no significant overall change in testing fees per patient-day.

“In this year-long randomized clinical trial, we found that displaying Medicare allowable fees for inpatient laboratory tests in the EHR did not lead to a significant change in overall clinician ordering behavior or associated fees,” the authors concluded. They suggested that future research should test more salient ways of presenting price transparency data to physicians.

A commentary published simultaneously in the same journal discussed the meaning of these findings and those from other recent studies for stakeholders who had hoped price transparency could be the key towards reducing wasteful utilization and relieving some of the cost burden on patients.

“One possible conclusion from this recent body of evidence is that making healthcare prices available at the point of care is not an effective strategy to decrease wasteful health care spending,” the authors wrote. “Yet we believe this is not the case.”

Instead, they continued, those developing such initiatives must strengthen their resolve and think about how to make price information better received by physicians and patients. For instance, the prices of care episodes instead of individual services may provide a stronger foundation for conversations about value. Furthermore, clinical decision support is critical to help deliver information about quality.

The lack of success resulting from current efforts “does not mean we should give up on increased price transparency in healthcare,” the commentary authors summarized. “Rather, a more thoughtful approach to the design, point of delivery, and context for health care price information is needed to achieve the promise of price transparency.”