Price transparency fails to rein in imaging use

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Brendon Nafziger, DOTmed News Associate Editor | January 24, 2013

At the end, average utilization in the active group increased about 3 percent (plus or minus about 4 percent), while it fell an average of 3 percent in the control group (plus or minus about 6 percent). However, the researchers said the average change of utilization between the groups was not statistically significant.

Explaining the disparity between results seen for price transparency on lab tests and their own findings for imaging, the authors said it might be because, in part, doctors already know at some level that imaging is expensive.

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"Cost transparency may serve to highlight the fact that these (lab) tests, which are often viewed as perfunctory and of little consequence, do indeed have financial consequence," they write. "Imaging tests, on the other hand, are widely known to be relatively expensive, even if the exact costs are somewhat underestimated."

Also, the authors note that doctors in a fee-for-service system are usually not incentivized to control costs, which is why it might be useful to run the study on providers in a bundled payment system, who would have more skin in the game.

As for why clinical decisions support systems might control utilization, Brotman said it's because the systems could simply be helping to drive good medicine, incentives or not.

"It's helping you make wise, evidence-based decisions," he said. "If you find yourself in the context of decision support that's neither wise nor evidence-based, you're less likely to execute that (procedure)."

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