Can Emergency Medicine Residents Predict Cost of Diagnostic Testing?

Diagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests. Needless and excessive spending may occur without an appreciation of the impact on the larger healthcare system. Knowledge regarding the cost of diagnostic testing among emergency medicine (EM) residents has not previously been studied. A survey was administered to 20 EM residents from a single ACGME-accredited three-year EM residency program, asking for an estimation of patient charges for 20 commonly ordered laboratory tests and seven radiological exams. We compared responses between residency classes to evaluate whether there was a difference based on level of training. The survey completion rate was 100% (20/20 residents). We noted significant discrepancies between the median resident estimates and actual charge to patient for both laboratory and radiological exams. Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs$57, and for computed tomography exams was $1,058. There was improvement in accuracy with increasing level of training. This pilot study demonstrates that EM residents have a poor understanding of the charges burdening patients and health insurance providers. In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula, and warrants further attention and investigation

Can Emergency Medicine Residents Predict Cost of Diagnostic Testing?

INTRODUCTION:  Diagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests.  Needless and excessive spending may occur without an appreciation of the impact on the larger health care system. Knowledge regarding the cost of diagnostic testing among Emergency Medicine residents has not previously been studied.METHODS: A survey was administered to 20 Emergency Medicine residents from a single ACGME-accredited three-year EM residency program, asking an estimation of the patient charges for 20 commonly ordered laboratory tests and 7 radiological exams. Responses were compared between residency classes to evaluate whether there was a difference based on level of training.RESULTS: The survey completion rate was 100% (20/20 residents).  Significant discrepancies were noted between the median resident estimates and actual charge to patient for both laboratory and radiological exams.  Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs$57, and for computed tomography (CT) exams was $1058.   There was statistically significant improvement in accuracy with increasing level of training. CONCLUSION: This pilot study demonstrates that EM residents have a poor understanding of the charges burdened by patients and health insurance providers.  In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors.  Education regarding the cost of providing emergency care is a potential area for improvement of Emergency Medicine residency curricula, and warrants further attention and investigation