Monday, June 17, 2013

ED Physicians are Clueless on Cost

Not a day goes by, it seems, the New York Times or some other equally prominent journalistic source publishes a scathing invective regarding the irresponsible cost of healthcare in the U.S.  In this context, it is equal parts highly entertaining and appalling to measure how ignorant Emergency Physicians are regarding the cost of the care they provide.

This single-center study performed in Philadelphia gives results similar to prior work in the same vein.  23 attending physicians and 21 residents were surveyed regarding estimates of cost of care for 102 of their patients discharged from the Emergency Physician.  Each estimate for the total cost of care was compared with the actual final charges billed to the patient or their insurance carrier.

Median estimated charge:  $1,268
Median actual charge:  $2,175

There was no difference between attending and resident performance.

Not an encouraging result – particularly as patients are likely going to be burdened with ever-increasing portions of their healthcare costs, and we ought to be able to communicate with them the cost of care as part of shared decision-making in the Emergency Department.

"Emergency physicians’ knowledge of the total charges of medical care"
www.ncbi.nlm.nih.gov/pubmed/23685055

2 comments:

  1. Having worked in a state with reasonable malpractice protection, I still find it maddening that people don't consider the costs of the workups they do. Most annoying is ordering the $600 viral panel on the febrile infant "so we can tell the parents what is going on."
    I often have to implore the residents to not order a test that won't change management unless the CDC makes us do it for epidemiology. Either way, teaching the residents/doctors how much things cost will surely decrease testing.
    I think CPOM should have a dollar amount that increases as you order things. Shouldn't be hard to get a study done that shows that.

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  2. ...and one of those studies was covered here, two months ago:
    http://www.emlitofnote.com/2013/04/mixed-cost-conscious-ordering-results.html

    Not as robust as your "running total" idea, which sounds like you need:
    http://grants.nih.gov/grants/guide/pa-files/PAR-08-269.html

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