A computer education program to improve physician awareness of rehabilitation hospital charges

Objective: To quantify physician knowledge of hospital charges and determine if computer fiscal feedback would improve physician awareness of hospital charges. Design: Comparison of physicians' knowledge of hospital charges before and 6 months after the instigation of a computer feedback educational program. Participants and Setting: All physicians (attendings, residents, and fellows) at a large academic rehabilitation hospital. Intervention: After surveying physicians' knowledge of hospital charges, the billing fees for some items were placed on the computer ordering menu so that these charges were viewed when orders were made by physicians. Main Outcome Measures: Error in physician charge estimates before and after computer education program, and physician confidence in charge estimates. Results: The baseline survey found that physicians had poor awareness of hospital charges, regardless of ordering frequency, relative charge for the item, or physician experience. Physicians expressed little confidence in their knowledge of the charges and were twice as likely to underestimate than to overestimate charges. Six months after the implementation of a computer feedback educational program, improvement was seen in the awareness of hospital charges for all imaging studies and most laboratory tests. Fiscal awareness of items that had not been included in the computer feedback also showed some small improvement. Physicians' confidence in their knowledge of fees improved. Physicians indicated the program was beneficial and should be expanded to include fiscal information on more services. Conclusions: Immediate computer feedback of hospital charges improves physicians' fiscal awareness and may lead to their practice of more cost-efficient medicine.