The team from the Harvey L. Neiman Health Policy Institute, led by radiologist Richard Duszak, Jr., MD, made an interesting inquiry into the quantity and nature of uncompensated imaging studies provided to emergency department (ED) patients, the results of which are published in the June issue of the Journal of the American College of Radiology.

Working with data provided by the billing company Zotec Partners, the team concludes that radiologists are loosing $2,584 per month…every month…2,835 of the 2,935 sampled…to uncompensated care in the ED. In fact, a total of 28 percent of care rendered by radiologists in the ED setting was uncompensated. The annual sum per radiologist is $31,008. That’s just uncompensated care in the ED and not elsewhere.

What the authors found most surprising was that insured patients account for nearly half of all uncompensated care.  Slightly more than 16% of the imaging services provided to patients with healthcare insurance in the ED is uncompensated, but that adds up to almost 48% of all uncompensated ED imaging services. In fact, the percentage of uncompensated care attributed to the insured may have been understated, because the uninsured were likely to have been billed the "list" price versus the contract price billed to the insured.

How much of that 16% is represented by uncollected co-pays, and how much of the total was unreimbursed because a deductible had not been met was not addressed. Nor could the authors say how much of the technical component went uncollected by the hospital.

Radiologists are not the only physicians with losses in the ED: The authors cite a recent study that found emergency medicine physicians average $71.04 per patient in uncompensated care, hopefully not as much as the 28% ding radiologists feel in that setting.

I wondered if the high rate of default goes back to that old invisibility issue: Patients don’t feel they have to pay the radiologist, because, typically, they don’t see him or her. That would not explain the fact that the imaging service with the highest percentage of failure to pay (35.8%) is interventional radiology.  Remember that the next time one of your IR partners has to get up in the middle of the night and go to the hospital.

Times are difficult, and some people will struggle to pay. I suspect a certain percentage of those patients who aren't paying their bills are giving hospitals and practices the slip because Americans, in general, aren't accustomed to paying for healthcare. When giving fundraisers the slip, people like to say, “I gave at the office.” Radiologists can now say, in all sincerity, that they gave at the ED.