Physician awareness of rehabilitation costs

Containment of health care costs is a pressing national issue. In this study, we examined physician knowledge of rehabilitation hospital costs by quantifying their awareness of hospital charges. All physicians at a free-standing rehabilitation hospital were surveyed. Approximately one-half of the physicians responded, including 19 attending and 17 resident physicians. The survey addressed three issues: physicians' estimate of the billing fee (hospital charge to the patient) for various items; how confident they were of the charge; and how frequently they ordered each item. The survey listed 65 items including diagnostic testing, drugs, therapies, and equipment. The average error in the charge estimates was quite large. For example, it was 52, 48, and 108% for hematologic tests, imaging studies, and pharmaceuticals, respectively. Charges were underestimated twice as often as they were overestimated. Physicians' confidence in their knowledge of these fees was quite low. They indicated that they were guessing 80 to 90% of the time, had an idea of the cost for 10 to 20% of the items, and were confident in their knowledge for less than 1% of the items. There were no significant correlations between accuracy of the charge estimates and ordering frequency, actual charge of the item, or experience level of the physicians.