Paid Price Information on Image and Procedure Ordering Rates

The Effect of Paid Price Information on Image and Procedure Ordering Rates

The investigators' study seeks to explore the impact of price information on physicians' ordering behavior and care quality. The investigators will evaluate the impact of the physician price transparency initiative at Atrius Health (ATRIUS) on rate of overall procedure and test orders, clinically inappropriate orders, and appropriate orders. Ultimately, this study will help stakeholders understand the degree to which price information can help improve the value of healthcare.

Study Overview

• Status: Completed
• Conditions: Healthy
• Intervention / Treatment: Behavioral: Single median price information; Behavioral: Paired inside/outside price information

Detailed Description

The investigators' study team worked with Atrius Health (ATRIUS) to design a physician price transparency (PPT) intervention aimed at providing primary and specialty care physicians with price information on commonly-ordered outpatient procedures (e.g., Pap smears, ECHOs, colonoscopies) and imaging tests (e.g., CTs and MRIs). The 2014 PPT intervention was built upon a pilot that ATRIUS conducted in 2010. Starting January 1, 2014, ATRIUS randomized its physicians to 3 different study arms, those receiving:

1. No price display for common outpatient procedures or imaging tests,
2. A single price for each procedure or test, or
3. A pair of prices for each procedure or test (that allowed physicians to compare prices that would be charged if the test was conducted at a facility within the ATRIUS network versus outside of it).

The mode for delivering this PPT intervention was ATRIUS' common electronic medical record (EMR), which all of its physicians use to place all orders related to outpatient procedures and imaging studies.

The investigators used a blocked randomized-controlled study design to quantitatively and qualitatively evaluate the effect of No, Single and Paired procedure and imaging test price information on: rate of overall procedure and test orders, clinically inappropriate orders, and appropriate orders.

The investigators used ATRIUS' administrative and EMR Data Repository to assess the quantitative outcomes proposed within this study. This repository contains the information the investigators need to block randomize at the practice level and to describe practices (e.g., size, location) and physicians (e.g., age, gender, specialty). It also captures all of the actions that physicians take when caring for patients (all orders are placed through their common EMR) and collects all of the information needed to assess clinical care quality using Healthcare Effectiveness Data and Information Set (HEDIS) measures. Data from this system have been used in numerous prior analyses of healthcare quality.

• Study Type: Interventional
• Enrollment (Actual): 1205
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Boston Children's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Providers who can place orders in the EMR independently and who have worked at ATRIUS since 2013.

Exclusion Criteria:

• Providers who do not use the common electronic medical record system, cannot place orders in the electronic medical record independently (e.g., registered nurses, licensed practical nurses, registered dieticians), worked after hours Telecom, or were per diem.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
NO_INTERVENTION: Control; Physicians in this Arm received only a paper memo with a list of common imaging tests and procedures.
EXPERIMENTAL: Single Price; Physicians in this Arm received a single median price in the electronic medical record at the time of ordering in addition to the paper memo.	Behavioral: Single median price information; Physicians in this Arm received a single median price in the electronic medical record at the time of ordering in addition to the paper memo.
EXPERIMENTAL: Paired Inside/Outside Prices; Physicians in this Arm received two prices (the inside and outside price) in the electronic medical record at the time of ordering in addition to the paper memo.	Behavioral: Paired inside/outside price information; Physicians in this Arm received two prices (the inside and outside price) in the electronic medical record at the time of ordering in addition to the paper memo.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Overall procedure and imaging test ordering rate	1 year
Choosing Wisely-based clinically inappropriate ordering rate	1 year
HEDIS-based clinically appropriate ordering rate	1 year

Collaborators and Investigators

• Sponsor: Boston Children's Hospital
• Collaborators: Robert Wood Johnson Foundation; Atrius Health
• Investigators: Principal Investigator: Alyna T Chien, MD, MS, Assistant Professor of Pediatrics, Department of General Pediatrics, Division of Medicine, Boston Children's Hospital

Study record dates

Study Major Dates

• Study Start: January 1, 2014
• Primary Completion (ACTUAL): December 1, 2014
• Study Completion (ACTUAL): October 1, 2016

Study Registration Dates

• First Submitted: November 19, 2015
• First Submitted That Met QC Criteria: November 20, 2015
• First Posted (ESTIMATE): November 23, 2015

Study Record Updates

• Last Update Posted (ESTIMATE): January 31, 2017
• Last Update Submitted That Met QC Criteria: January 30, 2017
• Last Verified: January 1, 2017

More Information

Terms related to this study

• Keywords: Physicians' ordering behavior with price information
• Other Study ID Numbers: P00011096