Capsule Commentary on Schiavoni et al., How Primary Care Physicians Integrate Price Information into Clinical Decision Making
Capsule Commentary on Schiavoni et al., How Primary Care Physicians Integrate Price Information into Clinical Decision Making
Maria G Frank 0
FACP 0
FHM 0
0 Denver Health Hospital Authority , Denver, CO , USA
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n this month’s edition, Schiavoni1 and colleagues describe
I their cross-sectional qualitative study in which they
conducted semi-structured interviews of 46 primary care
physicians (PCPs) from an accountable care organization (Atrius
Health) to better understand PCPs’ experience with disclosure
of price information on tests and procedures. The key findings
of this study were that PCPs were more interested in having
patient-specific out-of-pocket price information than the price
paid by insurers, which would not necessarily have an impact
on patients’ day-to-day finances. Having cost information
enabled providers to involve patients in treatment discussions
and to make informed choices regarding reasonably priced
medical care. PCPs reported that they were unlikely to change
their ordering patterns regardless of displayed cost
information, yet financial information was perceived as helpful when
trying to avoid patient-driven unnecessary testing. Also, most
PCPs agreed that price transparency in healthcare is crucial
and that it requires the engagement not only of patients and
practices, but also of society and healthcare payers (health plans).
The study1 results contrast with those previously published.
Goetz et al.2 identified 17 articles analyzing the effect of
displayed charges for both laboratory and radiology orders
as well as medication choice; they concluded that charge
information changed ordering and prescribing practices. These
results are consistent with those found by Horn et. al.3 Sinaiko
el al.4 also describe the potential benefit that price
transparency has on health cost savings; however, they focus on
patientled interventions rather than changes in physician prescribing
practices. The authors hypothesize that incorporation of cost
information into daily practice may influence providers’
perceptions of the degree to which this data influences their
ordering and prescribing patterns. This complex dynamic
may contribute to the differences found between Schiavoni’s
results and those previously published.
In an era of patient-centeredness, high-value care and the
Choosing Wisely® campaign, healthcare cost information
seems to be important to providers and patients alike;
however, further research is needed to help determine how best to
incorporate cost transparency into everyday practice.
Corresponding Author: Maria G Frank, MD FACP, FHM; Denver
H e a l t h H o s p i t a l A u t h o r i t y , D e n v e r , C O , U S A
(e-mail: ).
Compliance with Ethical Standards:
1. Schiavoni K , Lehmann LS , Guan W , Rosenthal M , Sequist TD , Chien AT. How primary care physicians integrate price information into clinical decision making . J Gen Intern Med . 2016 . doi:10.1007/s11606- 016 - 3805 -0.
2. Goetz C , Rotman SR , Hartoularos G , Bishop TF . The effect of charge display on cost of care and physician practice behaviors: a systematic review . J Gen Intern Med . 2015 ; 30 ( 6 ): 835 - 842 . doi:10.1007/s11606- 015 - 3226 -5.
3. Horn DM , Koplan KE , Senese MD , Orav EJ , Sequist TD . The impact of cost displays on primary care physician laboratory test ordering . J Gen Intern Med . 2013 . doi:10.1007/s11606- 013 - 2672 -1.
4. Sinaiko AD , Chien AT , Rosenthal MB . The role of states in improving price transparency in health care . JAMA Intern Med . 2015 . doi:10.1001/ jamainternmed.2015.0628. (...truncated)