The impact of cost displays on primary care physician laboratory test ordering

J Gen Intern Med. 2014 May;29(5):708-14. doi: 10.1007/s11606-013-2672-1. Epub 2013 Nov 21.


Background: Physicians are under increased pressure to help control rising health care costs, though they lack information regarding cost implications of patient care decisions.

Objective: To evaluate the impact of real-time display of laboratory costs on primary care physician ordering of common laboratory tests in the outpatient setting.

Design: Interrupted time series analysis with a parallel control group.

Participants: Two hundred and fifteen primary care physicians (153 intervention and 62 control) using a common electronic health record between April 2010 and November 2011. The setting was an alliance of five multispecialty group practices in Massachusetts.

Intervention: The average Medicare reimbursement rate for 27 laboratory tests was displayed within an electronic health record at the time of ordering, including 21 lower cost tests (< $40.00) and six higher cost tests (> $40.00).

Main measures: We compared the change-in-slope of the monthly laboratory ordering rate between intervention and control physicians for 12 months pre-intervention and 6 months post-intervention. We surveyed all intervention and control physicians at 6 months post-intervention to assess attitudes regarding costs and cost displays.

Key results: Among 27 laboratory tests, intervention physicians demonstrated a significant decrease in ordering rates compared to control physicians for five (19%) tests. This included a significant relative decrease in ordering rates for four of 21 (19%) lower cost laboratory tests and one of six (17%) higher cost laboratory tests. A majority (81%) of physicians reported that the intervention improved their knowledge of the relative costs of laboratory tests.

Conclusions: Real-time display of cost information in an electronic health record can lead to a modest reduction in ordering of laboratory tests, and is well received. Our study demonstrates that electronic health records can serve as a tool to promote cost transparency and reduce laboratory test use.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Diagnostic Tests, Routine / economics*
  • Diagnostic Tests, Routine / trends
  • Electronic Health Records / economics
  • Electronic Health Records / trends
  • Female
  • Health Care Costs* / trends
  • Humans
  • Male
  • Massachusetts
  • Medicare / economics*
  • Medicare / trends
  • Middle Aged
  • Physicians, Primary Care / economics*
  • Physicians, Primary Care / trends
  • Practice Patterns, Physicians' / economics*
  • Practice Patterns, Physicians' / trends
  • United States