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Cost consciousness among physicians in the neonatal intensive care unit

Journal of Perinatology volume 36, pages 1014–1020 (2016)Cite this article

Subjects

Abstract

Objective:

The objectives of this study were (1) to describe the prevalence and correlates of cost consciousness among physician providers in neonatology and (2) to describe knowledge of cost of common medications, laboratory/imaging evaluations, hospitalization costs and reimbursements.

Study Design:

A 54-item survey was administered to members of the Section on Neonatal-Perinatal Medicine of the American Academy of Pediatrics.

Results:

Of the 602 participants, 37% reported cost consciousness in decision making. Adjusting for years in practice, gender, training level, type of practice setting and region of practice, formalized education about costs was associated with increased cost consciousness in practice (adjusted odds ratio (AOR): 3.4; 95% confidence interval (CI): 1.2 to 9.8). Working in a private practice setting was also associated with increased cost consciousness when ordering laboratory (AOR: 3.0; (95% CI: 1.2 to 7.6)) or imaging tests (AOR: 2.0; 95% CI: 1.0 to 4.8).

Conclusions:

We found variation in knowledge of cost. Formal education about costs and working in a private practice setting were associated with increased cost consciousness.

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Acknowledgements

We recognize Mr Eugene Nguyen for his support with statistical analysis, Ms Elaine Maldonado and Dr Ara Balkian for providing information on hospital reimbursements and the APRDRG system, Ms Patti Duda from CHA for her assistance in providing CMI data and Mr Jim Couto for facilitating the distribution of the questionnaire. Finally, we are grateful to the members of the Section on Neonatal-Perinatal Medicine (SONPM) of the American Academy of Pediatrics for their thoughtful responses to this survey. Dr Lakshmanan is supported by the Confidence Foundation and the Saban Research Institute at Children’s Hospital Los Angeles.

Author contributions

Drs Wei, Osman and Lakshmanan made substantial contributions to designing the study, analyzing the data and interpreting the results. Drs Wei and Osman wrote the first draft of the manuscript. Drs Dukhovny, Romley, Chin, Hall, Ho and Friedlich made substantial contributions to designing the study, interpreting the results and critically revising the manuscript. All authors reviewed and approved the final version of the manuscript.

Author information

Authors and Affiliations

  1. Neonatology, Children’s Hospital Oakland, Oakland, CA, USA

    D Wei

  2. USC Division of Neonatal Medicine, Center for Fetal and Neonatal Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    C Osman, S Chin, P S Friedlich & A Lakshmanan

  3. Pediatrics, Oregon Health and Science University, Portland, OR, USA

    D Dukhovny

  4. Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA

    J Romley & A Lakshmanan

  5. Children's Hospital Association, Overland Park, KS, USA

    M Hall

  6. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    T Ho

  7. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    A Lakshmanan

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  1. D Wei
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Corresponding author

Correspondence to A Lakshmanan.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Wei, D., Osman, C., Dukhovny, D. et al. Cost consciousness among physicians in the neonatal intensive care unit. J Perinatol 36, 1014–1020 (2016). https://doi.org/10.1038/jp.2016.117

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