Pundits cite the cost of healthcare as one of the leading issues facing our country. Every year, an increasingly larger fraction of our GDP goes towards labs, images, and medications which are, often times, ordered for no meaningful purpose. Some will argue that physicians over-order tests for the sake of defensive medicine (“If I order everything, chances are that I won’t miss something worthy of a lawsuit.”) But that’s a different discussion all together.As a resident physician training with a cost-effective mindset, I think there’s a simple solution which could go a LONG way – have the major EMR systems like EPIC and Meditech list prices next to every lab, medication, procedure, and imaging modality. It doesn’t have to be a massive, triple red-flag, obstructive piece of text either. If I wanted to order a brain MRI “just to check something”, it would make me think twice if I saw:
"MRI Brain w w/o contrast ($5315.78)"
Do I really want to spend over $5,000 plus labor time to check something which may not even alter the management course? And what if waiting for that MRI makes the patient stay an extra day receiving telemetry-level care? Now extrapolate that to the countless labs and other “diagnostic” things we do. That’s a lot of money.
Even ordering morning labs has become arduous task of redundancy. There is no reason every patient should have a complete blood count (CBC) and basic metabolic profile (BMP) done every… single… day. Maybe we’ll think twice about signing orders when we’re prompted with routine AM labs costing hundreds of dollars?
It seems like a pretty straightforward addendum to the EMR framework, so I’d love to read your opinions on the topic! Maybe some programs have already implemented a “price tag” system?