Count Your Pennies: Costs of Medical Resident Deviation from Clinical Practice Guidelines in Use of Testing Across Three Unannounced Standardized Patient Cases

Inappropriateness in test ordering patterns were observed through unannounced standardized patient simulated cases. Certain tests (CBC, BMP, LFTs, and HBV) were more likely used wastefully across cases. Between cases, specific tests were ordered in an inappropriate manner (such as TSH for Asthma, LFTs for Fatigue, and BMP for Well visits). The per patient direct cost of low value testing rose above $20 per visit for the well visit, though the fatigue case exhibited the most variation. Notably, this excludes downstream (indirect) costs from standardized encounters alone. Knowledge of wasteful utilization patterns associated with specific clinical scenarios can guide interventions targeting appropriate use of testing.