Why are patients paying far less out of their pockets for mammography now than two decades ago—while shelling out a lot more for other common imaging exams?
That’s an easy pop quiz for many radiology watchers. In 2010 most health insurers began paying the full tab for women 40 and older who got screened for breast cancer. The payers had to do so, thanks to the Affordable Care Act.
Here’s a harder question. Why did out-of-pocket costs for ultrasound skyrocket 123% over the same period while climbing a steep but comparatively cheap 61% for CT and MRI?
The authors of a study published online Oct. 6 in JACR surmise the difference owes in no small part to targeted and steady reimbursement cuts for CT and MRI in the value-based payment era [1].
“[W]e believe it most likely that these have disproportionately slowed the growth of costs for those services (as well as patient share of these costs),” the researchers write.
The team pursued out-of-pocket spending trends on major imaging modalities between 2000 and 2019 by analyzing healthcare consumer data in the Medical Expenditure Panel Survey (MEPS). This is conducted each year by HHS’s Agency for Healthcare Research and Quality (AHRQ).
Led by corresponding author Kumar Mukherjee, PhD, of Philadelphia College of Osteopathic Medicine and senior author Richard Duszak Jr., MD, of the University of Mississippi Medical Center, the authors of the present study turned up some illuminating findings.
Got Comorbidities, Younger Years and/or Cancer History? That’s Going to Cost You
Not least among these, the period under review saw an overall increase of 90%—from $97.97 to $185.91—in mean out-of-pocket patient costs for non-invasive imaging examinations.
In addition:
- While patient out-of-pocket costs for mammography tumbled almost 33%, they swelled across all other modalities included in the study. Along with ultrasound’s 123.2% spike and CT/MRI’s 61.0% rise, radiography was up 81.0% in 2019 vs. 2000.
- The percentage of out-of-pocket expenses to total service costs increased for radiography (10.0% to 14.6%), ultrasound (12.6% to 20.0%) and CT/MRI (6.2% to 11.8%). These ratios reflect “an ongoing shift of imaging costs from insurers to individual patients,” the authors comment.
- In the decade following the go-live of the Affordable Care Act (2011 to 2019), mammography saw a 31.5% drop in mean out-of-pocket burden, declining from $36.49 to $25.
Further, the researchers found, out-of-pocket costs were suppressed by certain patient characteristics. These included older age, racial/ethnic minority status, female sex and governmental healthcare coverage.
Meanwhile, factors contributing to higher out-of-pocket costs included comorbidities, lack of healthcare coverage, younger age and history of cancer.
A Call to Step Up Efforts for Understanding, Countering ‘Financial Toxicity’ in Vulnerable Populations
In their discussion, Mukherjee et al highlight a 9% fall in mean out-of-pocket outlays for imaging services between 2009 and 2015, as it came only after a period that saw steep increases, 2000 to 2009.
Noting the consistency of this finding with those from prior studies, Mukherjee and co-authors suggest as a possible explanation the 2014 federal push to expand subsidies and Medicaid coverage for poorer Americans.
Between 2017 and 2019, they write, “we observed a sharp 34.7% increase in mean out-of-pocket costs, which could be related to abatement of possible ACA-related interventions,” they write. “This might additionally reflect a range of other policy changes such as decreased funds for outreach and enrollment assistance, eliminating of penalties for not having coverage, and other factors contributing to reduced access to and enrollment in health plans.”
More:
With evidence suggesting that increasing financial burdens may be a deterrent to patients receiving recommended diagnostic testing and treatment, this recent increase could have an adverse effect on outcomes and further increase existing health disparities. … Additional efforts are warranted in order to better assess financial toxicity in these vulnerable populations when ordering imaging services.”
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.