Lessons for teaching cost containment

Increasing financial restrictions on hospitals by the federal government and changing physician reimbursement procedures make it more important to control the use of medical care resources by physicians. A prospective controlled study was made of an educational program for the medical and surgical house staffs and for medical students designed to reduce unneeded orders for low cost, high volume ancillary and nursing services. The program was comprised of six mutually reinforcing components: lectures, medical record audits and reviews, group feedback in the form of cost summaries containing information on unnecessary ordering, hospital price booklets, current patient bills, and pertinent journal articles. Operating at a time of retrospective hospital cost reimbursement, the program achieved only modest reductions in the residents' and students' use of hospital services and no substantive effect upon hospital costs. However, the program participants accepted the program enthusiastically. Several factors crucial to such educational cost containment programs were identified. The authors believe that experience with the program has valuable lessons for other hospitals initiating cost-control efforts.