Purpose: Physicians have limited understanding of diagnostic and nondrug therapeutic costs. Cost awareness can influence ordering patterns of tests and interventions, and has been shown to lower health care costs. The aim of this study was to assess awareness of health care costs among internal medicine housestaff.
Method: We conducted an online survey among internal medicine housestaff at our institution, asking them to estimate the hospital charges and CMS (Center for Medicare and Medicaid) reimbursements for common labs (CBC, BMP, LFTs) and diagnostic tests (CXR, CT scans, MRI, echocardiogram and stress test). The survey was sent by email to all internal medicine housestaff, i.e. Post Graduate Year (PGY) 1-3. Responses were collected anonymously. Eighty-six residents completed the survey.
Result: Of the respondents, 39 (45.3 %) were PGY-1, 21 (24.4%) were PGY-2 and 26 (30.3%) were PGY-3. The percentage of our 86 housestaff subjects who accurately estimated CMS reimbursement (75% to 125% of the value obtained from CMS website) ranged from 7%-19% for commonly performed lab tests, 15%-31% for imaging studies and 30% for cardiac diagnostics. Data for some of the lab tests and imaging studies are below. Accurate estimates were even less likely for hospital charges, with mean estimates being grossly lower than the actual charges. No differences in estimate accuracy were seen by level of training.
Hospital Charge | Resident Survey: Median | Medicare reimbursement | Resident Survey: Median | |
| CBC with differential | $153 | $48 | $11 | $21 |
| Basic Metabolic Panel | $133 | $48 | $13 | $21 |
| Hepatic Function Panel | $277 | $50 | $13 | $25 |
| Chest X-ray | $419 | $115 | $56 | $60 |
| CT Abdomen & Pelvis | $7464 | $700 | $737 | $336 |
| CT Head | $3424 | $510 | $401 | $339 |
Conclusion: Cost awareness among residents was low. Accuracy of cost estimates did not increase with level of training. Education about charges and reimbursements for common tests and procedures should be included in the curriculum for students and residents, in hopes of influencing ordering behavior and mitigating health care costs.
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