Shift toward imaging outside the hospital could save billions

The financial case for outpatient imaging

According to Rosman, deputy chief of the radiology enterprise service at Mass General Brigham, the U.S. healthcare system spends approximately $3.5 trillion annually, with nearly three-quarters of costs tied to hospital-based care. The study found that shifting just 10% of hospital-based care to outpatient settings could save an estimated $125 billion per year.

“For perspective, the entire expenditure for physician care is $60 billion. We are saving more than double that just by moving 10% of care outside hospitals,” Rosman noted.

Radiology, in particular, presents a significant opportunity for cost reduction. The study determined that up to 25% of hospital-based radiology services could be transitioned to outpatient centers. Mass General Brigham has already adopted this model, with 83% of its imaging performed outside of hospitals, far surpassing the 42% recommended by the study. Rosman believes this indicates that potential savings may be even greater than the study estimates.

Benefits to healthcare beyond cost reduction

Apart from financial savings, moving imaging out of hospitals improves patient care by optimizing hospital resources. “It’s less expensive to image patients outside of the hospital, and it allows us to prioritize inpatients who require urgent care,” Rosman explained.

This shift also enhances patient convenience. Outpatient imaging centers offer faster scheduling, shorter wait times and a more comfortable setting for non-urgent procedures.

Just like clinicians should be practicing at the top of their license, facilities should take a similar approach, where the most complex and emergency care cases are cared for in hospitals, and the lower acuity cases and followup visits to imaging should take place outside of the hospitals.

"At Mass General Hospital, you don't want to be doing appendectomies there, right? You want to be doing the complex Whipple procedures. The appendectomy should be done in your local community hospital. Similarly, your follow-up CT scan can be done in your local imaging center outside the hospitals," Rosman explained.

Addressing challenges in the transition to outpatient imaging

While the move to outpatient imaging offers significant advantages, challenges remain. Medicare’s evolving approach to value-based billing and site neutrality will likely play a crucial role in incentivizing this shift. Some hospital systems have traditionally resisted moving services outside their enterprise to retain revenue. However, Rosman suggests that hospitals can still benefit by investing in outpatient centers, ensuring a more balanced approach to patient care and financial sustainability.

“This doesn’t have to be adversarial between hospitals and outpatient centers,” he said. “Hospitals can own and operate these outpatient facilities, creating an integrated network that serves patients more efficiently and cost-effectively.”

The findings of the study align with broader industry trends that emphasize value-based care and cost efficiency. As the healthcare landscape evolves, Rosman and his colleagues advocate for a system where patients receive care in the most appropriate setting, one that prioritizes both cost savings and optimal patient outcomes.