The medical imaging boom has revolutionized health care in the past 30 years, leading to earlier diagnoses and improved patient outcomes. It’s often essential in reaching a proper diagnosis and determining the best course of treatment. But when you “peel back the onion,” you’ll find layer upon layer of issues that warrant a closer look.
It’s a concern for insurance carriers, and it should also be a concern for employers.
When a doctor recommends a CT, MRI or PET scan, most patients automatically agree without considering the price tag … unless they’re writing the check. It’s much easier to spend someone else’s money. Especially when an insurance company pays the bill.
Too many tests, too much radiation, too much money
Medical imaging is one of the fastest growing health care sectors in the United States, contributing to the rising cost of our health care system. But it’s complicated. Research shows that high tech radiation tests are:
Overrated. Choosing Wisely, a coalition of doctors from dozens of medical fields, recommend delaying high tech medical imaging except when symptoms signal serious health issues. For example, most back pain will subside in about four weeks — with or without an MRI. One study says those who have an MRI are more likely to have surgery.
Overused. Even those whose livelihood depends on high tech imaging are calling for restraint. Image Wisely, a joint task force of radiation professionals, is dedicated to lowering the amount of radiation used and eliminating unnecessary procedures.
Overpriced. The average price of an MRI in the United States is more than double the cost in many other countries. In 2013, the average U.S. price was $1,145 compared with $481 in the Netherlands and $350 in Australia. Within geographic regions, prices also vary wildly. USA Today reports the cash price for identical MRIs near San Francisco ranged from $475 to $6,221.
Reason, not rationing
Insurance companies are highly aware of the exorbitant cost of medical imaging and potential overuse, which explains the surge in preauthorization requirements over the past few years. In fact, an entire sub-industry has formed to help insurance companies screen imaging requests and determine medical necessity.
The focus is on using evidence-based medicine and value pricing, moving away from the fee-for-service model that rewards quantity of care instead of outcomes.
An educational challenge
Addressing this issue, popular blogger MD Whistleblower notes that most people are skeptical insurance companies’ motives. But when individuals have “skin in the game,” it often opens their eyes to the wise use of medical resources.
For example, someone with rich health benefits may be quick to agree to an MRI on a painful back. On the other hand, an individual who must write a check may be willing to try exercise and physical therapy before turning to costly imaging tests.
Then there’s the hurdle of shopping for care: Finding accurate price information can be like looking for a needle in a very tall haystack. In Massachusetts, health cost transparency is the law, but transparency regulations vary from state to state. Also, there are many types of tests, so getting an accurate quote may depend on asking the doctor for specific CPT (current procedural terminology) codes.
Other factors that complicate the cost calculations are insurance companies’ negotiated rates, how much the individual has paid toward their deductible and plan design.
Equip employees to make wise choices
Convincing employees to forgo unnecessary tests can be challenging. It all boils down to engaging employees in their health care by helping them understand their coverage, raising awareness of your insurance company’s transparency tools and educating them about the dangers of overexposure and overtreatment.