Cost is king for patients, referrers mulling where to steer elective imaging, though other factors in play

Cost is king for patients and referrers mulling where to steer elective imaging, though other factors also come into play, according to new research published Friday. 

Amid rising healthcare costs, private insurers and radiology benefit managers are increasingly pushing patients toward lower cost imaging options. Researchers sought to better understand the reasons why consumers choose one site over another, sharing their findings in the Journal of the American College of Radiology. 

To do so, Cindy Yuan, MD, PhD, and co-authors utilized sophisticated polling and market analysis techniques to “better characterize the complex decision-making processes of patients and physicians.” Besides cost, other factors also came into play including the referring physician’s recommendation and convenience for patients, and the quality of images and radiologists’ work for ordering providers. 

“In summary, the level of service, in the broadest sense, provided to patients as well as referring physicians, remains a key component in the success of imaging ventures,” Yuan, with the Indiana University School of Medicine, and colleagues wrote Jan. 17. “Easily available appointments at a convenient imaging center with prior authorization services and a good reputation provides a recipe for success for radiologists and radiology practices.”

For the study, consumers and physicians were asked to rate the importance of various characteristics when deciding where to seek/send patients for imaging. Patients were recruited by national market research firm AmeriSpeak from its own proprietary panel, while providers were targeted via an American Medical Association survey sample. A total of 393 patients who had recently undergone a noncontrast MRI of the shoulder, lumbar spine or knee in the past two years responded to the survey. That’s alongside another 168 physicians who had ordered 12 or more such exams in the past year. 

Patients and referring providers both placed the highest value on copays or exam costs, including a sizable segment who cited money as the sole deciding factor. Additional deciding factors for patients included the recommendation of their primary care doc or other referring physician, along with convenient appointment times and locations. Meanwhile, physicians valued sites that deliver quality images and employ trusted radiologists, though a certain segment of the survey population placed greater importance on these traits than costs. Being able to self-review images was the least important factor, the survey found. 

“Most respondents stated that at least one of their preferred MR imaging sites offers assistance with securing a prior authorization (PA),” the authors noted. “Of the physicians whose preferred MR imaging sites offer PA services, nearly two-thirds of the respondents report that this PA service increases their likelihood of referring to those sites. Of those physicians without exposure to PA services, the majority reported that a PA service would make them more likely to refer to that imaging site.”

Yuan and colleagues offered four key takeaways from their analysis, which are geared toward academic medical centers. They believe their research suggests that imaging leaders can work to improve patient and provider satisfaction by finding trade-offs between lowering costs and other “nonmonetary traits.” 

1. Low-cost options likely to proliferate: “As more lower-cost, standalone imaging centers are developed, there will be increasing competition based on these traits, which are very important to patients and physicians. This should be a point of note for academic medical centers or other ‘higher-end’ radiology service providers—patients and referring physicians place a high value on location convenience and copay, so if services offered cannot adapt or otherwise compensate along other margins, there will be inevitable loss of volume/market share.”

2. Publicize these traits to differentiate from competitors: “One method of adaptation could be the active promotion and marketing of imaging centers and the interpreting radiologists for their quality and expertise. In other words, positioning of imaging providers as clinical experts and leaders could offset some utility losses from relatively less convenient locations and higher copays.”

3. Join the movement away from hospital-based imaging: “Additionally, many [academic medical centers] are already establishing their own standalone outpatient imaging facilities, which perform imaging in easier to access locations, but send exams back to the main campus for subspecialty interpretation—resulting in the best of both worlds for patients. However, AMCs are well-known to have higher pricing than their private practice counterparts and, since price/copay/cost is very important to both patients and referring physicians, addressing this disparity will also be important for the future success of AMCs.” 

4. There is a clear market desire for assistance with prior authorization: “The importance of the availability of PA services at an imaging referral site also emphasizes the critical nature of relieving the physician’s office of this responsibility. Improved PA services should also improve the ability to provide the patient an accurate projection of out-of-pocket costs, an obvious weak point of referring physicians.”