title: Emergency physician knowledge of reimbursement rates associated with emergency medical care.
abstract: OBJECTIVE
  We investigated emergency physician knowledge of the Centers for Medicare & Medicaid Services (CMS) reimbursement for common tests ordered and procedures performed in the emergency department (ED), determined the relative accuracy of their estimation, and reported the impact of perceived costs on physicians' ordering and prescribing behavior.
  
  
  METHODS
  We distributed an online survey to 189 emergency physicians in 11 EDs across multiple institutions. The survey asked respondents to estimate reimbursement rates for a limited set of medical tests and procedures, rate their level of current cost knowledge, and determine the effect of health expenditures on their medical decision making. We calculated relative accuracy of cost knowledge as a percent difference of participant estimation of cost from the CMS reimbursement rate.
  
  
  RESULTS
  Ninety-seven physicians participated in the study. Most respondents (65%) perceived their knowledge of costs as inadequate, and 39.3% indicated that beliefs about cost impacted their ordering behavior. Eighty percent of physicians surveyed were unable to estimate 25% of the costs within ±25%, and no physicians estimated at least 50% of costs within 25% of the CMS reimbursement and only 17.3% of medical services were estimated correctly within ±25% by 1 or more physicians.
  
  
  CONCLUSIONS
  Most emergency physicians indicated they should consider cost in their decision making but have a limited knowledge of cost estimates used by CMS to calculate reimbursement rates. Interventions that are easily accessible and applicable in the ED setting are needed to educate physicians about costs, reimbursement, and charges associated with the care they deliver.
authors.affiliation: Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, UT, USA. Electronic address: Camille.hollifield@hsc.utah.edu.
authors.forename: Camille
authors.initials: C
authors.lastname: Broadwater-Hollifield
authors.affiliation: Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, UT, USA.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Gren
authors.affiliation: Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, UT, USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Porucznik
authors.affiliation: Department of Surgery, Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Youngquist
authors.affiliation: Department of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, UT, USA.
authors.forename: David N
authors.initials: DN
authors.lastname: Sundwall
authors.affiliation: Department of Surgery, Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
authors.forename: Troy E
authors.initials: TE
authors.lastname: Madsen
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003625:Data Collection; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data; D014481:United States