Only 40% of ED Providers Identified Accurate Healthcare Costs

June 02, 2017 - Emergency department providers have little understanding of the healthcare costs associated with common visits, a recent Journal of the American Osteopathic Association study revealed.

The survey of over 400 healthcare professionals working in an emergency department showed that only four out of ten providers correctly estimated the healthcare costs associated with three common situations: a 35-year-old woman with abdominal pain, a 57-year-old man with dyspnea, and a 7-year-old boy with a sore throat.

“Healthcare professionals in the ED [emergency department] continue to have an inadequate understanding of the costs associated with care routinely provided in the ED,” the study stated. “Education concerning cost, such as through the computerized physician order entry, is likely to improve efficiency and decrease costs to the patients as well as the health care system overall.”

Researchers presented the vignettes to providers with a hypothetical medical history, focused physical examine, diagnostic tests, and interventions. Providers selected one total healthcare costs from four options for each patient case.

For two vignettes, a narrow majority of surveyed providers chose the correct healthcare costs range. However, almost an equal number of providers selected an incorrect option.

Providers were the most likely to correctly identify the healthcare costs for the first patient encounter involving a 35-year-old woman with abdominal pain. About 43 percent of providers selected the correct option.

Surveyed providers chose the most accurate healthcare cost range just 40.1 percent of the time for the case with a 7-year-old boy with a sore throat, followed by 32 percent of the time for the case with a 57-year-old man with dyspnea.

But the second most common response from emergency department providers for the dyspnea vignette was incorrect and received 31 percent of responses. For this vignette, the correct and most commonly selected incorrect healthcare costs selection was only off by one response.

Researchers found that emergency department providers with advanced training typically chose the higher healthcare costs range for the care delivered in all vignettes. Although higher levels of training strongly correlated with an increased perception of healthcare costs understanding.

“It is likely that over a career, a physician gains knowledge about the costs of various interventions, such as computed tomographic imaging, leading to a perception of increased understanding,” researchers explained. “However, we suspect that other fees, not in the control of these HCPs [healthcare professionals], such as room fees, nursing fees, and radiologist fees, can make up a large percentage of a patient's bill for an encounter. Education about these fees could inform HCPs’ decisions and aid in communication in the ED [emergency department].”

Providers from tertiary hospitals also tended to select the higher healthcare costs options compared to their peers from community or rural hospitals.

“The relationship between being employed at a tertiary hospital and choosing a higher cost could be due to the location of most of these facilities in larger cities where prices may be higher,” researchers stated. “It could also be explained by the realization of HCPs who work in this environment that a larger facility with more equipment and personnel carries higher inherent costs. Institution size and reputation have both been reported to be related to increased costs.”

To educate emergency department providers about actual healthcare costs, researchers advised healthcare organizations to incorporate and display diagnostic test costs in the EHR system and computerized physician order entry tool.

However, a recent JAMA Internal Medicine study found that adding Medicare allowable fees for inpatient laboratory tests to the EHR system did not result in fewer tests ordered or lower healthcare costs. Providers exposed to the price transparency tool actually increased orders by 1.3 percent in a year after implementation.

Providers also did not significantly order less expensive tests after viewing their healthcare costs in the EHR system. The ordering of the most expensive tests declined by just 0.01 tests ordered per patient-day, while ordering of the least expensive tests jumped by 0.03 tests ordered per patient-day.

Consequently, healthcare costs slightly grew from $37.84 per patient-day to $38.85 per patient-day.

Researchers in the Journal of the American Osteopathic Association study, however, noted that providers may realize more cost savings from emergency department interventions. Emergency department care tends to be the most expensive across settings and increased healthcare price transparency should help.

“These findings seem to indicate that improved understanding of cost would translate to decreased cost to both patients and the healthcare system overall to some degree,” they stated.