title: The Effect of Price Information on the Ordering of Images and Procedures.
abstract: OBJECTIVE
  Ordering rates for imaging studies and procedures may change if clinicians are shown the prices of those tests while they are ordering. We studied the effect of 2 forms of paid price information, single median price and paired internal/external median prices, on how often pediatric-focused and adult-oriented clinicians (most frequently general pediatricians and adult specialists caring for pediatric-aged patients, respectively) order imaging studies and procedures for 0- to 21-year-olds.
  
  
  METHODS
  In January 2014, we randomized 227 pediatric-focused and 279 adult-oriented clinicians to 1 of 3 study arms: Control (no price display), Single Median Price, or Paired Internal/External Median Prices (both with price display in the ordering screen of electronic health record). We used 1-way analysis of variance and paired t tests to examine how frequently clinicians (1) placed orders and (2) designated tests to be completed internally within an accountable care organization.
  
  
  RESULTS
  For pediatric-focused clinicians, there was no significant difference in the rates at which orders were placed or designated to be completed internally across the study arms. For adult-oriented clinicians caring for children and adolescents, however, those in the Single Price and Paired Price arms placed orders at significantly higher rates than those in the Control group (Control 3.2 [SD 4.8], Single Price 6.2 [SD 6.8], P < .001 and Paired Prices 5.2 [SD 7.9], P = .04). The rate at which adult-oriented clinicians designated tests to be completed internally was not significantly different across arms.
  
  
  CONCLUSIONS
  The effect of price information on ordering rates appears to depend on whether the clinician is pediatric-focused or adult-oriented.
authors.affiliation: Harvard Medical School, Boston, Massachusetts; alyna.chien@childrens.harvard.edu.|Division of General Pediatrics, Department of Medicine, and.
authors.forename: Alyna T
authors.initials: AT
authors.lastname: Chien
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Smitha
authors.initials: S
authors.lastname: Ganeshan
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Division of General Pediatrics, Department of Medicine, and.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
authors.affiliation: Harvard Medical School, Boston, Massachusetts.|Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.|Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.|National Center for Ethics in Health Care, Veterans Health Administration, Washington, District of Columbia.
authors.forename: Lisa Soleymani
authors.initials: LS
authors.lastname: Lehmann
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Hatfield
authors.affiliation: Kaiser Permanente of Georgia, Atlanta, Georgia; and.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Koplan
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts.
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, Massachusetts.
authors.forename: Anna D
authors.initials: AD
authors.lastname: Sinaiko
authors.affiliation: Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts.|Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.|Partners Healthcare System, Boston, Massachusetts.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Sequist
authors.affiliation: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
mesh_terms: D060866:Accountable Care Organizations; D003365:Costs and Cost Analysis; D003952:Diagnostic Imaging / Q000191:economics; D005249:Fees and Charges; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008404:Massachusetts; D050316:Medical Order Entry Systems; D000072143:Pediatricians; D010818:Practice Patterns, Physicians' / Q000191:economics*