High-deductible plans stressing patient imaging utilization, payments

by John W. Mitchell, Senior Correspondent | November 19, 2018
Imaging is not immune from an emerging trend of patient financial burden under high-deductible plans as a barrier to care, according to a just-published article in the Journal of the American College of Radiology (JACR).

Radiologists need to factor in such cost challenges in planning how to deliver care to patients and for their future practice strategy. Also, radiologists need to be mindful of pricing information provided to patients.

"There is very misleading information out there about the cost of imaging tests," Dr. David Levin, emeritus professor and chairman of Radiology at Thomas Jefferson University Hospital and lead author told HCB News. "This information comes from both hospitals and websites. Patients who have high-deductible plans and who price shop will get very confused and misinformed. Patients and people in health care need to be aware of this problem."
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Patients often find themselves facing high deductibles of between $3,000 to $7,000 or more, according to the authors. Such rising cost sharing is increasing bad-debt for hospitals and physicians. This patient financial strain, in conjunction with inaccurate pricing information, is a recipe for medical delivery problems, according to Lavin.

“Hospital-based radiologists need to be concerned [that] bad [pricing] information will make it erroneously appear to patients that their imaging costs will be much higher in hospital outpatient facilities than in the private office," he said.

The result, he added, is that hospitals and their radiologists could "lose a substantial" portion of their outpatient business. This could mean, said Levin, that hospital-based radiologists might "seriously" consider opening freestanding imaging centers to offer lower prices. This, because, the authors noted, private imaging centers could be more "nimble" in competitive pricing than hospitals. Due to this reality, the authors maintained, hospitals should consider lowering their imaging chargemaster rates to be more competitive.

The most promising strategy, according to the authors, is to better prepare patients about any out-of-pocket costs for imaging diagnostics. They cited software programs that would allow hospital staff to give detailed, “true” pricing and self-pay portions for an imaging procedure by insurance plan in response to patient cost inquiries.

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