High costs don't curb doctors from ordering imaging tests

IN A STUDY designed to see if doctors who are told the exact price of expensive medical tests like MRIs in advance would order fewer of them, Johns Hopkins researchers got their answer: No.

In a report published online in the Journal of the American College of Radiology, the researchers found that revealing the costs of MRIs and other imaging tests up front had no impact on the number of tests doctors ordered for their hospitalized patients.

“Cost alone does not seem to be the determining factor in deciding to go ahead with an expensive radiographic test,” said the study’s senior author, Daniel J. Brotman, M.D., an associate professor of medicine at the Johns Hopkins University School of Medicine and director of the hospitalist program at The Johns Hopkins Hospital. “There is definitely an over-ordering of tests in this country, and we can make better decisions about whether our patients truly need each test we order for them. But when it comes to big-ticket tests like MRI, it appears the doctors have already decided they need to know the information, regardless of the cost of the test.”

Studies in the past suggest that much of the expense of laboratory tests, medical imaging and prescription drugs is unknown or hidden from providers and patients at the time of ordering, leaving financial considerations largely out of the health care decision-making process and likely driving up costs, Dr. Brotman noted.

Other studies have shown that doctors ordered fewer laboratory tests in some cases when they were given the price up front. But Dr. Brotman said imaging tests appear to be “a different animal.”

There are built-in disincentives to ordering many major tests if they are not necessary, such as the potential danger of radiation used in some, he said. In addition to making physicians more sensitive to the costliness of unnecessary testing, Dr. Brotman said they need to learn how to explain to patients why they may not need them.

For the study, Dr. Brotman and his colleagues identified the 10 imaging tests most frequently ordered for patients at The Johns Hopkins Hospital. Dividing the tests into two groups, they made sure prices were attached to one group over a six-month period, from November 2009 to May 2010. He and his colleagues left out the pricing information for the other group over the same time period. Prices are not typically shared with physicians or patients in most medical settings.

When the researchers compared the ordering rates to the rates from a six-month period a year earlier, when no costs were displayed at all, they found no significant difference in ordering patterns.

Brotman said he might have been concerned if there was a large decrease in ordering expensive tests, as there are many instances when theAir Max