Cost Awareness Doesn’t Curb Image Exam Ordering

Health care providers don’t seem to order fewer or different imaging exams when cost of the studies is displayed, researchers found.

Other studies have shown that in some cases when price is a factor, providers order fewer lab tests. But imaging exams are a “different animal,” said Daniel Brotman, MD, associate professor of medicine at The Johns Hopkins University and director of the hospitalist program at The Johns Hopkins Hospital.

“Comparison shopping might not be as easy” with imaging tests, said Brotman, senior author of the study published online in the Journal of the American College of Radiology. If a patient needs a particular scan to determine an illness, there may be limited options, he said. In contrast, there may be lower-cost medications that are just as effective or lab tests that aren’t necessary.

“I don’t think the same logic applies to ordering imaging studies,” he said in an interview. “Providers are a little more cognizant to the fact that they may be exposing the patient to radiation or potentially discomfort when they order an imaging tests. The thought process of ordering an imaging test may be a little more detailed.”

For this study, researchers identified the 10 most frequently ordered imaging exams at The Johns Hopkins Hospital. They divided the tests into two grows, attaching prices to one group for six months. When researchers compared order ratings among the groups, there was no significant difference in ordering patterns.

Even though providers’ habits didn’t change when cost was displayed, cost should still be transparent, Brotman said.

“This is an education and awareness that is good for our health care system in general,” he said. “We need to be making an effort as care providers to be at least a little more familiar with the cost of what we are doing.”