Instead of Bureaucratic Rules or Time-Consuming Approval Requirements, Why Not Give Physicians Feedback about Their Utilization?
There are alternatives to forcing clinicians to call each other on the phone to get approval for every lab test, radiology test, and expensive medication they want to order. One alternative is to give clinicians feedback, every few months or so, about how much they utilize expensive diagnostic tests in comparison to their peers. Research has shown that such feedback reduces physicians’ utilization (Berwick and Coltin 1986; Schectman et al. 1991). Physicians hate feeling like they are outliers; they do not want to rely on expensive tests more than other physicians do. Such feedback systems deserve a role in helping control healthcare costs. They do not require burdensome rules, but they do not avoid bedside rationing. If physicians are only interested in patients’ best interests, they will completely ignore how their utilization patterns compare to other physicians. In fact, in a world without bedside rationing, they will continue to order what they think is best for their patients. Tho
