More on Patient Engagement

Financial incentives plus information decrease patient preference for potentially wasteful diagnostic testing

Discussing benefits and risks of low-value diagnostic testing via head CT scan with patients can reduce the prevalence of such testing.

Jeff Lagasse, Associate Editor

Providing financial incentives to forego testing significantly decreases patient preference for testing, even when accounting for test benefit and risk -- and since some tests are unnecessary, this has the additional benefit of potentially curbing wasteful spending in the healthcare industry.

That's the finding of a study published in the October issue of Academic Emergency Medicine, a journal of the Society for Academic Emergency Medicine, which explores the hypothesis that patient preferences for diagnostic testing will vary substantially when the patient is presented with different quantitative information about risk, benefit and cost.


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The single center survey indicated that patient "acceptance rate" for computerized tomographic imaging of the head varied substantially, even if the assumed risk and benefit of the test were varied only slightly: either 0.1 or 1%.

This work supports the hypothesis that discussing benefits and risks of low-value diagnostic testing via head CT scan with patients, even when absolute benefit or risk is very low, may impact patients' decision-making -- and can be the scientific cornerstone of a shared decision-making model to reduce low-value diagnostic testing.

And providing financial incentives to forego testing significantly decreased patient preference for testing, even when accounting for test benefit and risk, suggesting that implementation of a cash incentive to forego unnecessary diagnostic testing may further prove to be a successful method to decrease healthcare costs for ED patients.

Though the study was hypothetical in nature, it demonstrated that patient preferences for ED care decisions may be influenced by such financial considerations as out-of-pocket costs, especially in the case of using expensive tests like CT imaging.

The authors suggest that further study is needed on the impact of financial incentives on patient decision-making across other clinical scenarios and in non-hypothetical situations.


Work published earlier this year found a similar potential for reducing wasteful spending in the area of cataract surgery. Eliminating routine but unnecessary procedures before people undergo such surgery has the potential to save costs and resources for hospitals serving lower-income patients, UCLA researchers found in April.

Forgoing routine chest X-rays, electrocardiograms and other preoperative procedures -- which were found to have no clinical benefit prior to cataract surgery -- was associated with a savings of $67,241 over three years at one of the medical centers analyzed.

The change was also associated with other benefits -- for instance, one licensed vocational nurse had approximately 70% more time to pursue other clinical work. The researchers did not detect any measurable negative effects for patients associated with the change.

Twitter: @JELagasse

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