Tuesday, May 17, 2011

Daily blood work in hospitalized patients

According to a recent study published in the Archives of Surgery, merely giving doctors feedback on the hospital charges reduced costs:

Intervention  A weekly announcement to surgical house staff and attending physicians of the dollar amount charged to nonintensive care unit patients for laboratory services during the previous week.
Main Outcome Measure  Dollars charged per patient per day for routine blood work.
Results At baseline, the charges for daily phlebotomy were $147.73/patient/d. After 11 weeks of residents being made aware of the daily charges for phlebotomy, the charges dropped as low as $108.11/patient/d. This had a correlation coefficient of –0.76 and significance of P = .002. Over 11 weeks of intervention, the dollar amount saved was $54 967.

Of course that dollar amount is artificially inflated because it represents hospital charges rather than actual costs. All things being equal this means nothing to most patients and to Medicare and other payers that are based on DRGs. It's the hospital that's “out” the amount of money these extra tests cost.

But all things are not equal. There are other factors. A dropping hemoglobin picked up on the daily CBC enables the clin doc specialist to code “acute blood loss anemia” which might more than make up for the added cost. Similarly hyponatremia, hypokalemia or a rising creatinine on the daily chem profile might have the same effect.

Daily labs are necessary on some but not all patients. Most hospitalized patients on IV fluids need daily chemistries. There are probably multiple reasons why doctors do it to excess. CPOE may be a facilitator.

Via WSJ Health Blog

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