Nearly half of patients are liable for secondary imaging interpretation costs, with those who often can’t afford to pay in-full bearing the brunt, according to a new study.
Additional reads are performed by subspecialists or experts who didn’t order a patient’s original exam to help confirm or clarify complex cases. Demand for these second looks has ballooned as of late, and payers including Medicare have increased coverage for these opinions as a result.
Despite this, Emory University radiologists say costs are still falling onto patients. At their institution, patients received bills for 47.5% of services and made out-of-pocket payments for slightly more than 17%.
While the mean patient bill was small, nearing $27, and out-of-pocket payment even smaller ($14.55) a real problem is organizational lack of transparency, the Atlanta authors wrote July 19 in JACR.
“In situations in which there is no third-party payer or when reimbursement claims are denied, costs are borne directly by patients,” Sean P. Doyle, PhD, and colleagues with Emory’s Department of Radiology and Imaging Sciences, added. “When these patient liabilities are for secondary interpretations, they may come as surprises to patients who have already paid for their initial interpretations, thus imposing upon them additional and unexpected financial burdens.”
Doyle and co-investigators based their conclusions on more than two years’ worth of professional charges, insurance payments, patient bills and corresponding out-of-pocket payments. Overall, they relied on 7,740 secondary interpretations.
Younger and uninsured patients received higher bills and paid more for second opinions. At the same time, Black individuals and those with government-sponsored insurance faced smaller costs compared to white patients and the commercially insured.
Doyle and colleagues noted many radiology practices use secondary interpretations as an additional source of revenue. Mean professional charges for these exams were $306.50, with insurance reimbursement reaching $108.02.
Based on institutional data, patients’ out-of-pocket payments, however, did not fully cover costs in 68% of situations, the authors noted, suggesting “many” individuals may have difficulty settling up.
Organizations using secondary reads to bolster their bottom line should keep this in mind. But further research must also investigate if one-time payments save patients future headaches.
“What remains unknown … is how much downstream savings could result from better clinical decision making related to secondary interpretations and whether such upfront patient costs may ultimately result in overall reductions in financial burdens to both insurers and patients,” the group concluded.
Read the full study in the American College of Radiology’s peer-reviewed journal here.