With all the papers presented at this year’s OTA, one stood out to us: Paper #87 – “Do Surgeons Know the Cost of Orthopaedic Trauma Implants?”
It was presented by one of the several doctors who worked together to discover just how much surgeons know about the cost of the hardware they implant. These doctors hale from facilities such as The Mayo Clinic, Stanford University and the University of Pennsylvania, among others. In short, the study finds that surgeons, both attending and residents, have little understanding of the price of implants. You can read the findings here on page 284.
What would happen if they knew how much things cost? Johns Hopkins researchers found out in a study published by JAMA Internal Medicine. In “Doctors Go Shopping: Price Comparisons Lead MDs to Lower Testing Costs, ” Alexandra Sifferlin reports that the researchers gave physicians the prices of 62 commonly ordered tests. The researchers compared the buying behavior of the physicians and found that showing the pricing information resulted in a 9% cut in use of the tests overall and a savings of over $400,000 over the six months. By comparison, there was a 6% increase in the use of the tests without pricing information over the same time period.
“We generally don’t make decisions based on what is cost-effective … for our patients, but knowing the cost of things appears to make us more thoughtful about what we think might be best for their health,” said study author Dr. Leonard S. Feldman, an assistant professor of medicine at the Johns Hopkins University School of Medicine in a statement. “There’s a lot of waste in medicine because we don’t have a sense of the costs of much of what we do.”
These studies indicate that physicians do, in fact, have interest in cost and that they know the price/value equation has broken down in healthcare. There was a time when keeping doctors in the dark on the cost of care was inconsequential ; a long time ago, before burst debt ceilings and a middle-class dissipating at its fastest in 100 years. The talking heads of healthcare are all promoting an epic change from fee-for-service to pay-for-performance reimbursement to align doctors’ and hospitals’ interests as the answer to reducing costs. Perhaps in our frantic search to save healthcare we have overlooked a solution that we have taken for granted in the “age of information” – information. Far simpler than re-drawing reimbursement models, maybe we just need to open up a bit? Who wants to help people more than doctors? The power of information and human behavior may just be our best answer yet……