What if Empowering Patients Increases Imaging Use?
Health policy experts understand that reducing waste and overutilization of health care is critical in making our health care system sustainable. They also understand that to do this ethically, patients must be part of the process. Informed patients who can work together with their doctors to make smart decisions about their care and avoid costly tests and procedures that will not help them get better is the goal behind efforts like Choosing Wisely. However, as patients are empowered with more information about their health and the medical options open to them, assuming that they will always opt for less care is a big leap to make. Diagnostic imaging is a great example of this, as Boston Globe editorial writer Lisa Rosenbaum points out today. Studies show that diagnostic imaging tests performed on patients with back pain and no other symptoms are rarely useful. Patients typically get better on their own and having a study done may actually make the patient feel worse because they believe they are sicker. However, the catch is that patients who have imaging done are uniformly more satisfied with their care than patients who are told to simply wait and see if their symptoms improve. In our health care system, dissatisfied patients switch doctors and write negative reviews on physician rating web sites that potential new patients read. In addition, payors and Medicare are looking at patient satisfaction as a quality measure that can determine reimbursement rates. This means that there will soon be an even stronger financial incentive to keep patients happy. Is keeping patients happy a bad thing? It is a little like asking if politicians keeping voters happy is a bad thing. Sometimes it will lead to bad decisions, but generally these are balanced out by good ones. Provided patients are willing to assume the cost of additional imaging testing above that recommended for standard evidence-based care and -- this is key -- truly understand what they are getting for their health care dollars, empowering them may be a very good thing for health care overall and also the field of radiology. Take what is happening around informing women about their breast tissue density. Once a woman knows she has dense breast tissue that could mask tumors, it should be up to her if she would like additional ultrasound or even MRI screening for breast cancer. Yes, some of these tests are costly, but so are many other products and services in our free market. We would not presume to tell patients -- even poor patients -- willing to pay out of pocket that they can't purchase a cosmetic procedure, bariatric surgery or Lasik vision correction. For a woman with dense breast tissue and a family history of breast cancer, the peace of mind that may come from having an MRI in addition to mammography may well be worth a considerable personal expense. This should be her choice. Now consider that if we look to other health care services that are for cash only, our patient with dense breast tissue will not shop for additional diagnostic imaging testing by price alone. She will pick her provider based on a host of factors in addition to price, such as location, convenience, expertise of the practice radiologists, and amenities. (To see what I mean, just try to find a successful cosmetic surgeon with unprofessional marketing materials, poor customer service, and an ugly waiting room.) For more on the importance of gearing up for direct to consumer marketing, check out my colleague Steve Smith's latest column: Ready for Patients Who Shop Around?