Healthcare costs are the #1 cause of personal bankruptcy in the United States, and cost reduction is a major focus of current health policy. Data demonstrate the majority of medical costs are directly related to tertiary care, 20% of which results from diagnostic testing, and 30% of overall cost does not result in improved outcomes. Related harms from over‐testing, over‐diagnosis, and over‐treatment pose a serious threat to patient health. However, harm from overuse has not traditionally been taught to medical trainees, who typically experience strong incentives to over‐test. In academic medical centers, residents provide a large proportion of direct care and constitute a natural audience for targeted efforts to reduce costs from unnecessary testing.
We hypothesized that by 1) educating residents on the importance of high value, lower cost medical practice; 2) providing residents with the costs of basic lab tests; and 3) providing residents with an interactive cost analysis worksheet regarding actual costs of care to patients, we could improve resident awareness of over‐utilization of diagnostic lab tests and influence their pattern of test ordering.
We provided 2nd and 3rd year Internal Medicine residents on our 1‐month hospitalist medicine rotation interactive educational lectures about medical costs, high‐value medicine, and ways to limit overuse of lab tests for hospitalized patients. We then provided residents with an interactive worksheet, which guided them through calculation of the number of unneeded common labs (CBC, BMP, CMP, Mg, Phos, LFTs) they had ordered on a patient during the rotation. The worksheet included validated cost data, and produced a total cost of unnecessary testing for the selected patient. The worksheet also included an estimator function, which extrapolated this cost to a population of patients seen over the practitioner’s lifetime to illustrate the aggregate impact of over‐testing. We surveyed participating residents at the beginning, end, and 3 months following the clinical rotation to assess impact of our interventions.
Our pre‐rotation survey indicated that residents felt it is very important to consider cost‐effectiveness when selecting tests, but they were unaware of actual costs. Residents’ belief in the importance of cost‐effectiveness persisted in surveys immediately after and 3‐months following the rotation, and they indicated the lectures and cost worksheet markedly improved their understanding of actual costs. Importantly, the 3‐month post‐survey demonstrated a substantial increase in residents’ reported incorporation of cost into their daily clinical decision‐making. Qualitative comments from the 3‐month post‐survey indicated the curriculum we implemented was both practical—rather than theoretical, as much education about costs in healthcare are perceived to be—and highly unique in our residency training environment.
To cite this abstract:Lammers A, Kneeland P, Pierce R. Can Less Be More? A Practical Cost‐Conscious Experience for Residents. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 252. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/can-less-be-more-a-practical-costconscious-experience-for-residents/. Accessed March 31, 2020.