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Purchasing vouchers for imaging services could present safety risks and set customer up for upselling attempts.
Imaging services can be expensive, so getting a coupon for a deeply discounted scan could be enticing to a patient who is worried about his or her health. But, is marketing radiology services directly to a consumer for a much cheaper price actually safe and ethical?
Researchers from Brigham and Women’s Hospital set out to find out what happens when companies use internet-based services, such as Groupon, to encourage patients to purchase and pursue imaging services that their doctors have not necessarily ordered. Not only could this situation grow the number of unnecessary tests, but it could also cause a rise in false positives and incidental findings, they said.
The team, led by Sheena Desai, a current M.D./MBA student at Tufts University School of Medicine who was at Brigham and Women’s at the time of this study, published their results in a research letter in the Nov. 2 JAMA Internal Medicine.
Based on their review, Desai’s team discovered 84 companies in 27 states use Groupon to offer vouchers for 130 different types of imaging services, but only one company included a statement that mentions the potential risks that can be associated with medical imaging. And, with more than 28,000 of these coupons purchased as of February 2020, that can be problematic and dangerous, the team said in their letter.
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“Although free-market solutions can increase patient flexibility and curtail healthcare costs, consumer independence must be balanced with the potential for harm,” Desai said.
Specifically, customers can be persuaded to buy coupons based on unsubstantiated medical claims included in these promotions, potentially choosing to undergo unsafe exams.
To make this determination, Desai’s team examined vouchers offered on the “Imaging and Scans” section of Groupon to find active discount coupons. They also searched Google, using the keywords “Groupon medical scans.” They determined that patients purchased 28,380 imaging services vouchers through Groupon, and 45.2 percent of companies (38 organizations) that offered vouchers made unsubstantiated medical claims, such as crediting CT with being able to prevent heart disease and predict future heart attacks.
Looking at the coupons, CT was the most popular service, accounting for 41.3 percent of purchases followed by fetal ultrasound at 36.9 percent. And, the purchase prices were widely varied. The average costs ranged from $60 for a body or biofeedback scan to $687 for an MRI. More specifically, discounts could be as deep as 94 percent for a combination of CT scans, slicing prices from $1,569 to $95, and 34 percent for thermography studies, dropping price tags from $370 to $244. Average retail prices, the team said, were $126 to $2,000, respectively.
Customer responses and reviews of these vouchers were also equally varied, Desai’s team determined. Overall, the average customer rating from 2,044 reviews was 4.8 out of 5 stars. While some customer comments were positive because the services detected undiagnosed pathologies, including heart problems that led to subsequent interventions, 4.4 percent of reviews (90) revealed that companies tried to upsell additional imaging services. Other customers shared their negative experiences with the scans themselves – one individual who purchased a prenatal ultrasound revealed they were told the wrong gender of their fetus.
Ultimately, the team said, these direct-to-consumer (DTC) efforts will likely lead to greater price transparency for imaging scans, but it is unlikely that any of these appointments or consultations will result in patients receiving unbiased or thoughtful medical guidance. In addition, in most circumstances, there is a low chance that patients will be informed of the risks associated with imaging services.
The study did have limitations, though, the team said. They were not able to fully identify patients’ motivations for pursuing imaging, confirm sales, or evaluate exam quality. Consequently, more research is needed.
“Future studies should examine the appropriateness, accuracy, safety, and follow-up of DTC imaging services to determine their true benefit,” they said. “Improvement regulation of medical advertising is needed to reduce false claims and improve patient safety, thereby maximizing the benefits of DTC imaging services while minimizing the potential for harm.”