3 strategies to combat radiology’s high-deductible health plan problem

As a growing percentage of employers begin to favor high-deductible health plans (HDHP), patients are likely to start price-shopping for imaging tests. This may pose a threat to radiology practices, particularly those based in hospitals, wrote authors of a new Journal of the American College of Radiology study.

As part of their study, the researchers found prices quoted by medical institutions are often overinflated for a variety of reasons, including confidential rate agreements—leaving patients with unexpectedly high bills. As patients accrue these financial woes they will continually call hospitals or visit websites to find the cheapest option, wrote David C. Levin, MD, with Thomas Jefferson University Hospital in Philadelphia, and colleagues.

“Because the price listings from hospitals are generally far higher than those from private outpatient imaging facilities hospitals will find themselves at a competitive disadvantage and could well lose substantial amounts of their outpatient imaging business to private facilities,” they added.

To combat this, Levin et al. presented three potential strategies for providing the most accurate cost information to patients.

1. Contact the health insurer

Those who take calls from patients inquiring about prices could direct callers to reach out to their health insurer for a cost estimation based on what the insurer would pay if the deductible had already been met, the authors wrote. However, they acknowledged how difficult it can be to talk to a real representative, and if a patient managed to do so the insurer may be unwilling to provide cost information.

2. Imaging facilities can lower prices

This tactic was used by the Toledo Clinic in Ohio in 2015 in which they set their imaging chargemaster rates below those of hospitals in the area. They publicized a comparison in a local newspaper and on their website which drew criticism from competitors, but gave Toledo a competitive advantage, Levin and colleagues noted. Their prices were sill nearly double those offered by Medicare.

Similarly, Levin et al. pointed out the success of two large Midwestern radiology practices had in lowering their prices, and publishing them alongside local hospital chargemaster rates—which HDHP patients would not pay in full. Despite the somewhat misleading rates, the authors suggested the difference is likely to attract patients shopping around for imaging.

“It may not be easy for hospital-based radiologists to convince their institutional administrations to do so, but the present situation could result in hospital radiology departments pricing themselves out of the market,” the authors wrote. “Private imaging center fees are generally much lower than hospital chargemaster fees, but they too should consider further adjustments if their fees are more than double the Medicare rate.”

3. Provide accurate cost information

Imaging facilities could utilize software programs that match a patient and their plan and indicate the center’s negotiated fee when provided a CPT code, the deductible for a specific patient plan, how much of the deductible has been paid, and how much remains to be paid. While the estimated cost for the patient may not be exact, it would likely be in the ballpark.

“This approach is useful for private imaging centers but may not be available for hospitals because of the confidentiality concerns discussed earlier,” Levin and colleagues concluded.