Radiology experts warn of unintended consequences stemming from imaging price transparency efforts

Radiology experts are warning of possible unintended consequences stemming from imaging price transparency initiatives. 

The Centers for Medicare & Medicaid Services first implemented the Hospital Price Transparency rule in 2021, hoping to empower patients with more knowledge when making their healthcare decisions. Imaging is among the various “shoppable” services that providers are required to disclose pricing for, experts wrote in the Journal of the American College of Radiology [1]. 

However, radiology researchers are expressing concern that this information may be motivating some to shy away from undergoing scheduled imaging. Based on an analysis of 532 encounters, patients with pre-exam cost knowledge were less likely to complete their appointments (odds ratio: 0.33) when compared to those without such insight. 

“Our study highlights a need for policies that ensure price transparency initiatives are effectively integrated into patient-provider interactions at the time of ordering the test or treatment, rather than solely relying on patients to seek out cost information independently,” corresponding author Gelareh Sadigh, MD, a radiologist and researcher with the University of California, Irvine, and colleagues wrote Oct. 14. “Further, financial screening and proactive financial counseling interventions that can address patients’ concern about [out-of-pocket costs] and mitigate medical financial hardship should be integrated into patient interactions.”

Sadigh et al. pulled their information from two previous studies related to imaging pricing. The final sample included adults who completed or missed a scheduled outpatient CT, MRI or PET/CT exam sometime between late 2022 and May 2023. Outreach to study subjects included an email message complemented by phone and in-person encouragement to fill out a brief survey. 

Patients who completed their imaging appointments were more likely to be white, college educated or live in a less-disadvantaged neighborhood. Conversely, those who canceled their appointments were likelier to be unemployed or scheduled for an MRI. 

About 15% of participants reported having knowledge about out-of-pocket costs prior to their appointment. Among those who were aware, common sources of information were the patient directly asking their insurer (23%) or individuals already being aware of their insurance benefit design without needing to inquire (19%). Another 17% received pricing information from the imaging center without asking. Only about 11% used their health insurance price-estimator tool and 5% used the radiology provider’s pricing assistant. 

Out of 345 patients who completed their exam, 12% had beforehand knowledge about out-of-pocket costs. That’s compared to about 22% of the 187 patients who canceled their imaging appointment. Among 81 OOPC-aware patients, actively looking for cost information was more common for patients with missed imaging appointments (63%) as opposed to patients who completed their exams (34%). Out of 41 patients who canceled their appointment and had upfront cost knowledge, 54% reported rescheduling at the same imaging center. Another 7% switched the appointment to a different location, and 15% did not reschedule at the time of the survey. 

“Cost discussions are critical in shared decision-making between patients and physicians. Patients facing financial hardship often consider cost discussions essential for building trust with their physician,” the authors noted. “However, if there is no patient-physician interaction in the transparency process (e.g., patient simply obtaining the price from price estimator or billing office) as seen in this study, then it may lead to care delays. Additionally, price-sensitive patients are more likely to actively seek out prices, and one may argue the higher rate of cancellation among patients with pre-imaging OOPC awareness is due to them being more price sensitive. However, our study confirmed the independent association between awareness of OOPC before imaging and imaging completion regardless of patients’ socioeconomic status or level of financial worry.”

Read more about the results, including potential study limitations, in JACR at the link below.