Keeping Physicians in the Cost-Savings Loop

With numerous payment models in healthcare and each one focused on value, clinicians are often called upon to be part of the cost-saving equation. A problem arises when clinicians don’t know what they are looking for to achieve that outcome. This is where cost transparency becomes necessary.

Greg Hall, MD, serves as chief medical information officer at the New Hanover Regional Medical Center in Wilmington, N.C., an organization spearheading the cost transparency movement by making it possible to display costs to clinicians via their EHR through its Price Transparency Project.

At the Healthcare Information and Management Systems Society (HIMSS) Annual Conference in Las Vegas, Hall spoke about how having price information at the point of care is helpful in allowing physicians to practice cost consciously.

Currently, some clinicians are ordering therapies and medicine while being unaware of cost. According to Hall, this is because cost saving measures are not part of their workflow. "You can put out newsletters, hang posters, and send emails, but if it's not right in front of the doctor, it's not going to happen," said Hall.
Besides incorporating cost saving strategies into a practice’s workflow, Hall cited the importance for practices to utilize a scalable approach, require minimal education, and be sure to not come off as mandating choices to physicians.

"Doctors don’t like being told what to do. If you show a provider something is cheaper, they will take that into consideration," said Hall.
Practices must determine how physicians order medications and identify them as necessary. Some examples Hall gave were order sets, preference lists, and "one-off" orders.

A custom preference list is easy to use and offers physicians limited choices based on cost effectiveness. The list organizes medications by disease state, rather than in general. A preference list also recommends the dose, frequency, and formula information. "We use custom preference lists to almost trap [clinicians] into choosing the right thing," said Hall.

For "one-off" orders, the cost display shows the facility cost rather than the cost to the patient, to demonstrate the implications for the practice.

To show the importance of cost saving to physicians and other members of a practice, Hall recommends looking closely at the cost impact of expensive and less expensive medications. "The small drugs can do a lot of damage to your hospitals budget. Don't always focus on the stampeding elephants; the army of ants can eat away at you," said Hall.

One example Hall used was if a practice chooses to administer 4mg of ondansetron through an IV, it costs $2.25. That same medication in tab form costs $0.50. To better point this out to practice staff, Hall recommends showing them numbers, not just relative cost.

Hall recommends displaying this information at the point of care by adding a "daily cost estimate" column to the EHR, while also displaying the cost options in order. "Providers want to do the right thing, but they also want to do the easy thing. If you can move something up to the top of a list, they will do that," said Hall.