title: A Randomized Trial of Displaying Paid Price Information on Imaging Study and Procedure Ordering Rates.
abstract: BACKGROUND
  Prior studies have demonstrated how price transparency lowers the test-ordering rates of trainees in hospitals, and physician-targeted price transparency efforts have been viewed as a promising cost-controlling strategy.
  
  
  OBJECTIVE
  To examine the effect of displaying paid-price information on test-ordering rates for common imaging studies and procedures within an accountable care organization (ACO).
  
  
  METHODS
  Block randomized controlled trial for 1 year.
  
  
  METHODS
  A total of 1205 fully licensed clinicians (728 primary care, 477 specialists).
  
  
  METHODS
  Starting January 2014, clinicians in the Control arm received no price display; those in the intervention arms received Single or Paired Internal/External Median Prices in the test-ordering screen of their electronic health record. Internal prices were the amounts paid by insurers for the ACO's services; external paid prices were the amounts paid by insurers for the same services when delivered by unaffiliated providers.
  
  
  METHODS
  Ordering rates (orders per 100 face-to-face encounters with adult patients): overall, designated to be completed internally within the ACO, considered "inappropriate" (e.g., MRI for simple headache), and thought to be "appropriate" (e.g., screening colonoscopy).
  
  
  RESULTS
  We found no significant difference in overall ordering rates across the Control, Single Median Price, or Paired Internal/External Median Prices study arms. For every 100 encounters, clinicians in the Control arm ordered 15.0 (SD 31.1) tests, those in the Single Median Price arm ordered 15.0 (SD 16.2) tests, and those in the Paired Prices arms ordered 15.7 (SD 20.5) tests (one-way ANOVA p-value 0.88). There was no difference in ordering rates for tests designated to be completed internally or considered to be inappropriate or appropriate.
  
  
  CONCLUSIONS
  Displaying paid-price information did not alter how frequently primary care and specialist clinicians ordered imaging studies and procedures within an ACO. Those with a particular interest in removing waste from the health care system may want to consider a variety of contextual factors that can affect physician-targeted price transparency.
authors.affiliation: Harvard Medical School, Boston, MA, USA. alyna.chien@childrens.harvard.edu.|Department of Medicine, Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA. alyna.chien@childrens.harvard.edu.
authors.forename: Alyna T
authors.initials: AT
authors.lastname: Chien
authors.affiliation: Harvard Medical School, Boston, MA, USA.|Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.|Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.|National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA.
authors.forename: Lisa Soleymani
authors.initials: LS
authors.lastname: Lehmann
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Hatfield
authors.affiliation: Kaiser Permanente of Georgia, Atlanta, GA, USA.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Koplan
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Carter R
authors.initials: CR
authors.lastname: Petty
authors.affiliation: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Sinaiko
authors.affiliation: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.|National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA.|Partners Healthcare System, Boston, MA, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
mesh_terms: D060866:Accountable Care Organizations; D000328:Adult; D000066491:Clinical Decision-Making; D003363:Cost Control; D003952:Diagnostic Imaging / Q000191:economics* / Q000706:statistics & numerical data; D057286:Electronic Health Records; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008404:Massachusetts; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data
keywords: electronic health record; health services research; randomized trials