From the 2024 HVPA National Conference
Alexandria Markley MD (Mount Sinai Morningside-West Hospital, Sarah Kosse MD, Madeline Fenianos MD, Randy Leibowitz DO, Krystle Hernandez MD, Vasundhara Singh MD
Introduction:
In the ever-evolving field of healthcare, the need for physicians to understand cost considerations is increasingly paramount. Cultivating cost awareness among medical residents, who stand at the threshold of their professional journey, is critical as residents play a pivotal role in shaping the future of medicine. However, the incorporation of cost-consciousness into medical education remains a challenge, often overshadowed by clinical priorities. By examining current practices and understanding of cost awareness in residency training programs, the necessity of integrating cost-consciousness into the core curriculum of medical residency programs can be determined. Embracing a holistic approach to medical education that encompasses both clinical excellence and fiscal responsibility is essential for ensuring the delivery of high-quality, value-based care in the years to come.
Methods:
A cross-sectional survey was conducted among internal medicine residents using a questionnaire. The survey included questions assessing knowledge of the costs of common inpatient lab tests and imaging, perceptions of cost awareness, and attitudes towards evaluating cost when ordering tests. The cost of common labs and imaging was incorporated into four interactive afternoon report and didactic sessions, where a clinical case was discussed among internal medicine residents. During the session, residents were divided into breakout groups and encouraged to order the minimum tests needed to reach a diagnosis. The group ordering the least expensive tests while still reaching the diagnosis won. The prices were obtained from the hospital’s standardized Medicare cost list and the online cost-estimator calculator from the hospital’s website that provided a price range depending on insurance coverage. A post-intervention survey was then conducted at the end of the session.
Results:
When comparing the total number of question responses in both the pre-survey (n=170) and post-survey (n=166), there was a 41% increase in the number of questions with correct responses. 85% of the total residents who participated in the pre-survey stated that they do not feel comfortable with their knowledge about the cost of common labs and imaging ordered inpatient. In addition, 90% of residents stated that they do not have adequate access to information about the cost of common labs, imaging, and procedures. However, 75% of residents stated that they agree that physicians should factor in cost when ordering common labs. After the cost-awareness session, 75% of residents felt knowing the cost of laboratory and imaging tests will change the frequency with which they order these studies. 93% of residents who participated in the post-survey agreed that participating in the cost awareness session improved their knowledge about the cost of common labs and imaging.
Conclusion:
The incorporation of cost-consciousness into medical education holds profound implications for patient care and healthcare system sustainability. Although some residents had received prior education on cost containment during their medical training, there were significant gaps in their knowledge of the costs of common medical tests. By providing residents with the knowledge and skills to navigate the complexities of healthcare costs, we empower them to advocate for the delivery of value-based care. Integrating cost awareness into the medical residency curriculum will help bridge the gap between clinical expertise and fiscal responsibility. High-value care teaching in an interactive and repetitive method with the goal of integrating cost awareness into physicians’ practices helps ensure both the health and financial well-being of patients.