Paid Price Information on Image and Procedure Ordering Rates

The investigators' study team worked with Atrius Health (ATRIUS) to design a physician price
transparency (PPT) intervention aimed at providing primary and specialty care physicians
with price information on commonly-ordered outpatient procedures (e.g., Pap smears, ECHOs,
colonoscopies) and imaging tests (e.g., CTs and MRIs). The 2014 PPT intervention was built
upon a pilot that ATRIUS conducted in 2010. Starting January 1, 2014, ATRIUS randomized its
physicians to 3 different study arms, those receiving:

1. No price display for common outpatient procedures or imaging tests,

2. A single price for each procedure or test, or

3. A pair of prices for each procedure or test (that allowed physicians to compare prices
that would be charged if the test was conducted at a facility within the ATRIUS network
versus outside of it).

The mode for delivering this PPT intervention was ATRIUS' common electronic medical record
(EMR), which all of its physicians use to place all orders related to outpatient procedures
and imaging studies.

The investigators used a blocked randomized-controlled study design to quantitatively and
qualitatively evaluate the effect of No, Single and Paired procedure and imaging test price
information on: rate of overall procedure and test orders, clinically inappropriate orders,
and appropriate orders.

The investigators used ATRIUS' administrative and EMR Data Repository to assess the
quantitative outcomes proposed within this study. This repository contains the information
the investigators need to block randomize at the practice level and to describe practices
(e.g., size, location) and physicians (e.g., age, gender, specialty). It also captures all
of the actions that physicians take when caring for patients (all orders are placed through
their common EMR) and collects all of the information needed to assess clinical care quality
using Healthcare Effectiveness Data and Information Set (HEDIS) measures. Data from this
system have been used in numerous prior analyses of healthcare quality.

Inclusion Criteria:

• Providers who can place orders in the EMR independently and who have worked at ATRIUS
since 2013.

Exclusion Criteria:

• Providers who do not use the common electronic medical record system, cannot place
orders in the electronic medical record independently (e.g., registered nurses, licensed
practical nurses, registered dieticians), worked after hours Telecom, or were per diem.