The American Association of Clinical Endocrinologists 21st Annual Scientific and Clinical Congress:

Endocrine Physicians and Nurses Unaware of Testing Costs

Endocrine physicians and nurses are generally not aware of the costs associated with diagnostic testing and treatment, which may contribute to the rising cost of health care. Nikhil Gupta, MD, et al, of the University of Pittsburgh, evaluated cost consciousness via an online survey distributed to the endocrine division of an academic medical center to determine whether consideration for cost influences the number of diagnostic tests ordered.1

Thirty clinicians responded to the survey; 14 (47%) were attending physicians, 7 (23%) were fellows in training, and 9 (30%) were nurses. All respondents were presented with a hypothetical patient exhibiting symptoms of thyrotoxicosis, and were then asked to estimate the hospital charges and the Center for Medicare and Medicaid Services (CMS) reimbursements for common endocrine labs and imaging tests that would be ordered for this patient in order to make a diagnosis.

Most of the respondents could not provide the accurate CMS reimbursements or hospital charges, with an accurate CMS reimbursement range of 3% to 33% for various lab tests, and a range of 10% to 27% for imaging studies. No difference was seen between attending physicians, fellows, and nurses. With regards to the hypothetical patient mentioned in the survey, respondents requested an average of 4.3 tests in order to make a diagnosis. However, once the respondents were prompted to consider “cost effectiveness” when ordering their tests, the number decreased to 2.9 tests ordered (p < 0.05).

Investigators concluded that the low level of cost awareness can be attributed to several factors:

  • Difficulty in obtaining cost data
  • Substantial difference in actual amount charged versus reimbursement received
  • Apathy among providers stemming from the notion that “everything is covered by insurance.”
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