Tough sledding for patients using hospital ‘transparency’ tools to obtain imaging price estimates

In a recent dry run, more than three-quarters of several hundred healthcare consumers shopping for lumbar spine MRI succeeded in navigating to cost estimation tools within four hospital websites.

However, less than 28% of the compensated patient stand-ins completed the full mock assignment at hand: Obtain out-of-pocket price estimates from all four.

Mulling the gap, radiology researchers behind the project surmise many hospitals have much work to do before their online cost estimators progress from merely present for the public—and satisfactory for CMS compliance—to the point at which they become truly helpful for patients.

Corresponding author Gelareh Sadigh, MD, of Emory University and colleagues describe the experiment in a study published online Sept. 20 by JACR [1].

The team recruited 476 qualified English-speaking surrogate patients through Amazon’s Mechanical Turk (MTurk) platform, which matches project hirers with at-home gig workers.

Prior to posing as self-pay patients seeking non-contrast MRI of the low back, the MTurkers viewed a three-minute video presenting the basic how-to’s of digital estimator tools in healthcare.

Participants also completed a survey on their health literacy, prior imaging experience and so on.

On the back end, the cohort would be asked to grade the estimators using a system usability scale (SUS).


Patients Grade Estimators No Higher than C+

Reviewing the results after the surrogates completed the grading exercise as well as the tool-engagement task, Sadigh and co-researchers found nearly 10% of the field could not locate any of the four hospitals’ online cost estimators.

Further, while 67.4% found at least one cost estimator across the hospital websites, only 27.7% came back with the correct price from all four.

As for the grading of the estimators’ usability on a scale of a possible 100, the average SUS ranged from 62.4—which would be a failing grade in high school—to 77.5 (C+).

On this the authors comment that there’s room for improvement “if the goal of these tools is for patients to use them.”

Unsurprisingly, a hospital whose estimator closely resembled one shown in the tutorial video had the highest SUS.

The authors further report that the surrogate consumers achieved higher price accuracy as they progressed through experiment, suggesting practice might eventually pay off.  


Even Educated, Digital-Savvy Healthcare Consumers Struggle

In their discussion, Sadigh and co-authors remark that, clearly, patients seeking accurate out-of-pocket cost estimates from hospitals’ online tools have their work cut out for them.

The researchers underscore the failure of more than two-thirds of participants to retrieve accurate estimates from all four hospitals in the study—despite the field’s consisting entirely of MTurk workers, who “are generally younger, more highly educated and have better internet skills compared to typical U.S. workers.”

In addition, the discrepancy between 76.9% locating estimator tools and only 27.7% consistently using them as intended “suggests a usability issue with the price estimator interface.”

Importantly, the authors point out, CMS requires hospitals to list prices for their 300 most shoppable services in a consumer-friendly format or an online estimator tool.

Radiology services are often considered shoppable and so are commonly included in online estimator tools, they add.


Although the CMS regulation does not apply to private radiology practices since most are not hospital-based, they likely benefit from implementing online estimators, especially in a price-competitive market.”

JACR has posted the study in full for free (PDF).

Dave Pearson

Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.

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