By Kate Madden Yee, staff writer

August 25, 2017 -- Patients want to know how much an imaging procedure will cost, but healthcare pricing discussions happen in less than half of patient-physician encounters, according to a review published recently in the American Journal of Roentgenology.

Why? Physicians often don't know the costs of imaging tests themselves, wrote a team led by Dr. Gelareh Sadigh of Emory University in Atlanta. And patients may have trouble articulating their financial questions.

Physicians "may fail to fully engage with patients regarding their financial concerns," Sadigh and colleagues wrote. "In addition, some patients have difficulty clearly and explicitly expressing their financial concerns, or they may [express them] only to support or ancillary staff after their encounters" (AJR, July 25, 2017).

To further complicate matters, even if patients find pricing information -- perhaps via online tools -- it may not give them an accurate picture of the cost-to-benefit ratio of an exam, Sadigh told

"The majority of price transparency websites show patients the charge prices for an imaging exam, not their out-of-pocket cost," she said. "And they don't necessarily help patients discern the quality of the imaging center."

Transparency targets

Elective medical imaging is most commonly performed in the outpatient setting. As such, radiologists should recognize that patients may frequently consider imaging examinations as shoppable -- and should expect patients to seek price information, the authors noted.

 Dr. Gelareh Sadigh
Dr. Gelareh Sadigh from Emory University.

"Many [patients] will need to become familiar with the process of obtaining information using price transparency tools, and, thus, leveraging support staff to educate them about terminology and online material ... could prove quite helpful," they wrote.

More than half of patients are interested in obtaining price information -- particularly regarding out-of-pocket spending -- before they receive medical services, and about a fifth report that they compare price information before obtaining care. Yet despite the fact that patients want to know how much their healthcare will cost, it's still rare for physicians and patients to discuss the issue: Patients say these kinds of conversations happen in only 14% of encounters with physicians, while physicians say they happen 44% of the time.

Another problem is that physicians aren't always knowledgeable about the costs of tests and procedures they order. In one survey, 76% of physician trainees across different specialties incorrectly estimated Medicare's national average total allowable fees for common imaging tests -- regardless of how often they ordered them, Sadigh and colleagues wrote. Another study found that physicians in an academic primary care practice incorrectly estimated prices of common imaging and lab tests by 40%.

"The challenge for us as physicians is that we often don't know what resources the patient has, or where they are in their yearly deductible," contributing author Dr. Richard Duszak Jr., also of Emory University, told

Some physicians are concerned that if patients know the cost of imaging exams, they will focus less on quality and more on price. But this isn't necessarily true, the authors noted: One study found that most patients don't consider conversations about price as a way to reduce healthcare spending.

"In a study of patients requiring elective plastic surgery, for example, patients who were aware of prices were actually 41% more likely to schedule a procedure than were patients who were unaware of prices," they wrote.

Is it helpful?

For healthcare pricing information to be helpful, it must offer accurate estimates of actual out-of-pocket costs, not an average or "sticker price" charge, Sadigh and colleagues wrote. Patients may try to research costs using online tools -- some of which are free -- but these tools often only show aggregate ranges of possible charges, are based on old pricing or claims data, or are limited in the types of procedures they include.

Having "only charge or price information available ... can mislead patients and cause them to select lower-priced providers who might, for example, have older equipment or be less convenient," the authors wrote.

Both patients and doctors need to understand the pricing terminology as well, they wrote. Terms such as "cost," "charge," and "paid price" can be used incorrectly:

  • For facility and physician providers, "cost" is defined as the expenses incurred during the delivery of the healthcare service. It includes both variable costs (supplies and salaries) and fixed costs (those that keep a hospital running smoothly).
  • The amount providers ask to be paid is the "charge" -- or the "sticker" or "list" price. Charges are often inflated compared with costs.
  • The "paid price" refers to what insurers pay and what patients pay out of pocket.

"Knowing what these different terms mean is key to helping patients understand imaging costs," Sadigh told "And it's not only radiologists who need to know, but also practice staff."

Be proactive

So what can radiologists do to make imaging price information more available to patients? It helps to be proactive, according to the authors.

"With price transparency imperatives overall as well as increasing attention to medical imaging spending, radiology practices should anticipate increased interest in this issue and proactively meet the needs of patients and referring physicians," they wrote. "Indeed, this makes good business sense because enhancing financial communications with patients can boost both consumer satisfaction and loyalty."

Sadigh and colleagues offered four practical steps radiologists can take:

  1. Understand the terminology.
  2. Be aware of your own charges. What do patients see when they price shop your practice?
  3. Train technologists and staff to offer patients guidance about price transparency tools, advising them to be wary of their accuracy and aware of the variability between different imaging centers.
  4. Educate patients about quality variability between facilities and providers, and emphasize that price is not necessarily the primary deciding factor for obtaining imaging services.

Radiologists need to be aware of what their services cost, and they need to be able to direct patients to resources that will help them make informed decisions, Duszak said.

"As valuable as our services are, we need to remember that many of our patients incur out-of-pocket costs when they agree to an imaging exam," he said. "So when we recommend a particular exam, we need to provide our patients with a rationale for the test so that they can make a good decision -- and also have a basic sense of what the exam will cost, even if that's ballpark Medicare pricing."

Copyright © 2017

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