Medical imaging is facing a tsunami, also known as high deductible health plans, David Levin, MD, of Thomas Jefferson University Hospital in Philadelphia, PA, said at ACR 2015.
Levin is referring to a problem that radiology hasn’t had to face until recently. The New York Times published an article in December 2014 about the discrepancies in costs of exams. One of the examples in the article was for an echocardiogram, billed for $11,579 in Pennsylvania and $403 in North Dakota. In both cases, Medicare reimbursed around $400.
“Patients are becoming extremely price sensitive,” Levin said. “A couple of years ago, there was no such thing as patients shopping around for reasonably priced imaging services.”
Levin noted that as patients shop around, they are going to recognize these huge price discrepancies. Some might argue that patients don’t only care about costs, they care about quality of care as well, and may be willing to pay more for that quality. For those people, Levin cited a study in JAMA in which around 500,000 employees of 18 large corporations were given access to a price transparency platform. A search on the database would provide personalized out-of-pocket costs for each individual based on their insurance design, network, and deductible status. Over 37,000 patients had either an MRI or CT during the study period, 2,200 of whom did a prior search on the transparency platform. Claims payments for those who did the search were 13% lower per exam.
It’s not just patients that are seeking out lower priced imaging facilities, though. Levin said that bigger payers, like Aetna, Humana and United have started rewarding patients for choosing lower cost options. These patients could receive a cash reward of up to $100 for choosing a lower cost facility, and a nurse would help them make appointments at the lower cost facility.
The problem with the numbers, Levin said, is that they are basically just a hodge podge of real, imaginary, and greatly exaggerated numbers.
“[But] whether you like it or not, that’s what we have to deal with,” Levin said.
Imaging centers are going to need to come up with a strategy for their business in a high deductible health plan era, Levin said. But there is no single, set answer. A lot of the strategy will depend on how strong a facility’s presence is in their local marketplace, how the deductibles are structured, and the payers’ market share.
So there isn’t a good answer yet, Levin said. “But we have to think about this, we all have to be aware of this, and we all have to start planning for it.”
The slideshow shows some examples of tools patients can use to search for imaging prices.