Numbers of errors and bases for cost estimates by service missed or used unnecessarily in each variant
| Case | Service | CPT | Cost (US$) | Type and number of errors by variant | |||
| Baseline | Biomedical | Contextual | Biomedical/contextual | ||||
| Worsening asthma | Additional inhaler (symbicort) | 163.79 | M=9 | M=1 | |||
| Switch to generic inhaler (symbicort) | 163.79 | M=13 | M=14 | ||||
| Prescribe anti-acid RX (20 mg omeprazol) | 29.99 | U=1 | M=22 | U=1 | M=16 | ||
| Cardiology/pulmonary referral | 99 203 | 158.67 | U=1 | ||||
| Social work consult, 1 h | 30.00 | M=14 | M=15 | ||||
| Chest x-ray | 71 020 | 83.35 | U=3 | U=1 | |||
| Hypertension | TSH | 84 443 | 23.47 | U=6 | M=14 | U=4 | M=14 |
| Care for disabled child to permit surgery ($95/day) | 2850.00 | M=20 | M=23 | ||||
| Syncope | Adjust insulin dose (Humulin R) | 46.99 | M=6 | M=2 | M=1 | ||
| Stress ECHO | 93 350 | 640.08 | U=2 | M=8 | U=2 | M=7 | |
| Cardiac stress test | 93 017 | 244.07 | U=3 | U=4 | |||
| ECHO | 93 312 | 895.59 | U=3 | U=2 | |||
| Cardiology/pulmonary referral | 99 203 | 158.67 | U=1 | M=8 | U=0 | M=7 | |
| 24 h Holter monitor | 93 225 | 115.94 | U=3 | U=5 | |||
| 30-day event monitor | 93 270 | 103.75 | U=1 | U=2 | |||
| Carotid dopplers | 93 880 | 451.61 | U=1 | ||||
| Chest x-ray | 71 020 | 83.35 | U=1 | U=1 | |||
| Cardio loop recorder test | 93 270 | 103.75 | U=1 | ||||
| Thyroid function tests (TSH, Total T3, Total T4) | 84 443 | 48.51 | U=1 | ||||
| 84 480 | |||||||
| 84 436 | |||||||
| Prescribe β blocker (50 mg Toprol XL) | 35.99 | U=2 | |||||
| Prescribe isosorbide mononitrate | 46.99 | U=1 | |||||
| Novolog FlexPen ($199.27) and training (nurse, 1 h, $32) | 231.27 | M=20 | M=17 | ||||
| Glucometer (OneTouch with test strips) | 126.99 | M=6 | M=2 | M=1 | |||
| Weight loss | Chest x-ray | 71 020 | 83.35 | Missed | U=12 | U=11 | U=16 |
| CT abdomen | 74 150 | 519.94 | U=2 | U=1 | U=1 | ||
| CT pelvis | 72 192 | 520.51 | U=2 | U=1 | U=1 | ||
| CT thorax | 71 250 | 532.10 | U=2 | U=1 | |||
| ECHO | 93 312 | 895.59 | U=1 | ||||
| Ultrasound abdomen | 76 700 | 248.62 | U=1 | ||||
| Labs for malignancy | 83.35 | M=1 | |||||
| HIV test | 86 689 | 144.26 | U=1 | ||||
| Treatment for depression (30 mg Paxil), referral | 47.00 | M=4 | M=4 | ||||
| Social work consult, 1 h | 30.00 | M=14 | M=22 | ||||
Costs are in 2009 US$ and based on a 30-day time horizon. Costs associated with CPT codes are based on Medicare reimbursement schedules and include both facility and professional cost; drug costs are based on Medicare average sales price. ‘M’ indicates that the service should have been provided in the variant, and errors are the number of encounters in which it was missed. ‘U’ indicates that the service should not have been provided in the variant, and errors are the number of encounters in which it was unnecessarily provided. Empty cells indicate no errors made (either service was appropriate and never missed, or inappropriate and never unnecessarily provided).
CPT, Current Procedural Terminology; ECHO, echocardiogram; TSH, thyroid-stimulating hormone.