Price transparency a hot topic, but many patients still caught off guard by imaging bills
Although well-intentioned, price transparency initiatives pertaining to shoppable imaging services might not provide reliable or useful information to patients. A new paper published in the Journal of the American College of Radiology recently offered explanations as to why this is sometimes the case.
Co-authors Mohinee Mukherjee of Emory University Rollins School of Public Health and Michal Horný of Emory University School of Medicine explained that there are two aspects of billing complexity that make providing reliable price estimates to patients difficult: the number of parties involved in providing care, and billing for fees and ancillary services outside of the actual imaging exam itself.
“A key issue is the complexity of health care products. A single health care encounter from the patient’s perspective often consists of several complementary services. What services will comprise a health care encounter—and, ultimately, appear on a patient’s medical bill—varies across providers based on contractual agreements with payers,” the authors explained.
The authors’ recent analysis of more than 5 million outpatient imaging encounters revealed just how frequently patients are billed by multiple entities for what amounts to just one imaging exam. They found that 70.9% of hospital-based encounters resulted in multiple bills for a single exam. These rates were markedly lower for office-based encounters and exams completed at imaging centers, at 4.5% and 7.6%
The use of iodinated contrast was also found to play a role in bill complexity, with more than half of encounters utilizing the image agent resulting in separate bills across all three care delivery settings.
This, the authors explained, can make obtaining an accurate price estimate for imaging services difficult for patients, as they would have to seek out multiple entities separately to gather billing and fee information. Additionally, many patients are unaware of factors that would influence how they are billed, such as ancillary fees and organizational setups that use parties offsite to interpret imaging studies. In turn, the pricing information patients receive prior to exams is often incomplete.
"These findings may be apparent to health care professionals, but they may not be obvious to patients," they wrote.
The authors suggested that, in order to protect patients from being caught off guard by their imaging bills, more collaboration is needed between payers, policy makers and providers.
The study abstract is available here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.