When The Price Tag Is Missing

In a recent post, I talked about the growing interest among our patients and families – driven by increased cost sharing – in understanding what care is costing them, and the difficulty in answering that question.   A recent study in Pediatrics illustrates the problem.  Residents and attending hospitalists at Children’s Hospital of Philadelphia were surveyed about their knowledge of costs, charges, and payments for a range of common tests and treatments.  The respondents were not confident in their knowledge: only 13% of attending and 3% of residents rated their understanding of hospital finances as at least moderately adequate.  The large majority of both groups expressed a desire for knowing more.

It turns out they need to.  The median percent error was 75% for attending and 80% for residents.  Only 15% of estimates were within 25% of the actual value, and the magnitude of errors were similar for costs, charges, and payments.  However, both groups tended to overestimate costs, while underestimating charges and payments.  Arguably, the latter two are what matter most to patients who will have to pay at least a portion of the bill.  In addition, there appeared to be a certain tendency toward the middle: overestimates were more common for the least expensive items, while the costs and charges for the most expensive items tended to be underestimated.

If our patients and families are becoming more price-sensitive, and are asking more about what services will cost them, we need to prepare providers to deal with that.  Moreover, we know that making clinicians aware of costs can reduce unnecessary “routine testing” and other resource utilization.  This study shows that we have a long way to go in terms of getting accurate information into the hands of providers.  One of the advantages of an electronic health record is the ability to embed that information into the ordering process.  Interestingly, the Pediatrics study was done at an institution using Epic; it’s not clear whether they include any price information to the ordering provider.

Transparency, anyone?

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