Without a doubt, patients are shouldering a larger portion of their healthcare spending these days. This takes the form of higher premiums, deductibles, copays, and coinsurance. In my role as the executive director of Grand Traverse Radiologists, PC, I have observed that, as a result of these higher costs, patients are beginning to demand greater price transparency — a trend that is also borne out in the literature.
A Question of Quality and Complexity
So, how easy is it for patients to shop for imaging services? Although quality and continuity of care should figure into the discussion about where to pursue care, the tools available to help patients shop for imaging services have limitations. Many of these tools provide an incomplete picture, allowing the patient to search using criteria such as price, location, and whether the service provider is “participating” with their health insurance. Missing from this range of criteria is the notion of quality, which is important because more expensive doesn’t equate to better.Years ago, I came across a physician’s office that displayed a price board for various services; it looked similar to what one might see at a car repair shop (example shown below). It was a simple yet effective way for patients to learn, in advance, what they could expect to pay for services provided.
Why don’t we see this approach today? There are websites that enable patients to look up one service at a time (if they know precisely what they need), but physical pricing charts in facilities are a thing of the past. Ideally patients would be able to simply walk into an imaging facility and view pricing information presented alongside quality scores on an easy-to-understand price board. What other industry exists where the consumer isn’t told the price before the service is provided? Why is it so challenging to find this information in advance when it comes to imaging?
The short answer: for healthcare in general — and for radiology in particular — quality and the patient’s out-of-pocket cost depend on too many factors to keep the conversation simple. For instance, imaging quality criteria might include the age of the equipment, the technologist’s experience, the radiologist’s expertise, patient experience rating, or the amount of radiation given during the service. Cost factors are not as straightforward as one might think, either: complexity of the patient’s clinical condition(s), the exact amount of time spent with the patient, the details of the service that will be performed (for example, a head CT with or without contrast), the patient’s insurance coverage agreement (i.e. covered services, deductibles, copays, coinsurance), as well as the hospital and provider contracted prices with the insurance carrier, all affect ultimate costs.
That being said, it’s still worth asking the question: is there a better way to help the healthcare consumer get a handle on cost and quality of imaging services before their imaging encounters? One potential idea would involve developing a price and quality matrix for the most widely used services. Radiologists could incorporate the cost and quality metrics they deem most relevant based on their market area. Examples could include ACR accreditation, board certification, sub-specialization, number of services performed for highly specialized care, relative radiation dose, participation status with key payers and price. The imaging industry could work to create a quality index score based on this type of information: an “imaging seal of approval.”
A Complex Problem
The price board approach works well when the physician knows up front what specific service the patient is going to need, and when the patient is responsible for their entire bill. The provider and patient can work out how the bill will be paid at the time of service. There is no need for a multiple-tabbed Excel spreadsheet to determine the contracted rate, what service is part of a deductible, whether coinsurance or a copay is owed, or if the service is even covered by the patient’s insurance plan.
In my experience with imaging services, however, the complexity of most billing situations doesn’t lend itself to the price board scenario. For starters, in many cases, there are separate bills for the facility and for the radiologist. Because of this, it is difficult to find tools that can accurately predict the costs incurred by patients when it comes to imaging services. And many of the online tools that do exist only address high-cost items and lack information regarding quality, the latter of which should be a key component to understanding cost.
In part 2 of this blog post, I’ll explore the all-important component of quality as it relates to price transparency in greater depth.