Talking to Patients About Imaging Costs

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An increasing number of health insurance plans, including many of those offered on the new Affordable Care Act health insurance exchanges, come with high deductibles that can make advanced diagnostic imaging hard for some patients to afford, even with insurance. How practices approach speaking with referral sources and patients about cost is a complicated issue.

From a communications standpoint, it is always important to first identify the elephant in the room and tackle that main issue head on. For the cost of imaging — and any advanced medical care — that issue is that you are putting a price on a human being's health and well being. This is a deeply uncomfortable and emotional realization, and it is not surprising that most people in health care prefer to talk about value, safety, quality, efficiency and pretty much anything else besides cost.

However, facing down that elephant allows you to develop a message for patients and referral sources that is based on honesty. Saying, yes, there is a cost to advanced medical imaging that puts some patients in a difficult financial position allows you to then speak to patients and referral sources about what your practice is doing to advance cost transparency so that patients are not surprised by unexpected charges. It also allows you to accrue good will by saying what your practice is personally doing help make its services as affordable as possible. For example, if you offer patients charity care, give discounts for paying cash (oftentimes a better option than paying the deductible on the insurance negotiated rate), allow patients to pay in installments, or work with a financial institution that can help patients get a loan or a medical credit card, you should not be shy about saying so.

Cost is not a fun topic, of course, but it is one increasingly on the minds of patients and your referring doctors who worry about their patients' ability to afford treatment. The imaging providers who can look past the distasteful element of discussing a test or procedure's relative benefits compared to costs, will do their patients a tremendous service.

I recently had the opportunity to interview a group practice of plastic surgeons and came away deeply impressed with the value they put on open and honest communication with their patients. They were not the least expensive practice in their area, but they were a rare group practice where the surgeons collaborated on achieving the best outcomes for their patients. Every initial consultation with a patient began with listening, understanding the issue from the patient's perspective and then offering the patient their recommendations with complete information on what to expect at each step in the process, including from a cost perspective. The goal was to put the patient in control and make sure there were no surprises.

Can most imaging patients say the same, or do many read their explanation of benefits from the insurance company with shock and surprise?

There is demand for cost transparency and better communication from imaging providers. Several companies, including SaveOn Medical ( which we've written about here) are offering online tools to help patients shop around for the diagnostic imaging provider with the best location, technology and price. Others, including teleradiology provider USARAD, are expanding to offer for-cash second reads of imaging studies to patients who either do not understand or do not trust the initial report. (More here.)

If we agree that patients are not being unreasonable in wanting diagnostic imaging studies whose value they can understand, then maybe it is time to get over the reluctance to discuss imaging costs.