Providing cost information as a tool to change physician behavior

Abstract

Study objectives: Emergency physicians are required to provide cost-effective care for their patients. We determine whether providing education materials to emergency physicians will improve their cost awareness and enhance their confidence to make better cost-benefit decisions. Methods: This was a pre- and postintervention survey in an urban Level I trauma center/teaching hospital. Participants were all full-time emergency medicine staff, residents (postgraduate year [PGY] 1, PGY2, PGY3), and physicians' assistants. Providers were excluded if they were not working in the ED during the study. A table of charges for common laboratory tests, studies, and treatments was displayed in physician charting areas. All providers were surveyed before and 30 days after the charge information was made available. The survey included a table with 45 various laboratory tests, studies, and treatments, which was completed by the provider. A visual analog scale (VAS) was used to assess the providers' confidence in their knowledge of costs. Data were analyzed using t test and analysis of variance. Results: Fifty-three (100%) eligible providers were enrolled, and 100% of the surveys were completed. Before intervention, physicians' accuracy overall was 27.4% (95% confidence interval [CI] 22.8% to 32.0%) and was significantly improved to 44.9% (95% CI 39.9% to 49.9%; P =.02) after the intervention. Improved accuracy was found in 26 (58%) of 45 tests. Physicians rated their overall knowledge of charges using a VAS. The mean VAS before intervention was 29.0 (95% CI 23.0 to 35.0) and increased to 49.6 (95% CI 44.7 to 54.4; P =.01) after the education. Conclusion: Cost knowledge, accuracy, and physician confidence in their knowledge improved by displaying charge information.