Category: Patient Engagement

Do Imaging Costs Scare Patients?

Posted on by Brian Casey

A new study in JACR reveals an uncomfortable reality about medical imaging price transparency: Patients who knew how much they would have to pay for their imaging exam were less likely to complete their study. 

Price transparency has been touted as a patient-friendly tool that can get patients engaged with their care while also helping them avoid nasty billing surprises for out-of-pocket costs. 

  • Price transparency is considered to be so important that CMS in 2021 implemented rules requiring hospitals to disclose their standard charges online, as well as post a user-friendly list of their services that includes prices. 

But given that the rules were implemented relatively recently, not much is known about how they might affect patient behavior, such as compliance with recommended follow-up imaging exams.

  • Indeed, a recent study by some of the same authors found that patients are largely unaware of how much their imaging exams will cost them. 

So researchers analyzed data from two previously published studies of patients who either completed or were scheduled for outpatient imaging exams in Southern California. 

  • Patients were asked if they had been told how much their exam would cost them out-of-pocket when they scheduled it. 

Of the 532 patients who were surveyed, researchers found …

  • Only 15% said they knew about their out-of-pocket costs before their imaging exam. 
  • Fewer patients who completed their exams knew their costs compared to those who canceled (12% vs. 22%).
  • Patients who knew their costs were 67% less likely to complete their appointment than those who didn’t (OR=0.33).

So what’s the solution? The researchers suggested that healthcare providers may need to take a more proactive approach to disclosing price information to patients.

  • One possibility would be to integrate pricing discussions into patient-provider communications when ordering imaging exams, rather than relying on patients to seek pricing information on their own. 

The Takeaway

The findings show that medical imaging price transparency is more complicated than just posting a list of prices online and expecting patients to do the rest of the work. Imaging providers may need to get more involved in pricing discussions – the question is whether many of them are ready for it.

Patients Unclear on Imaging Costs

Posted on by Brian Casey

A new study in Health Policy and Technology shows that patients are surprisingly unclear on how much their imaging exams will cost them. Researchers found that few knew their imaging facilities had price estimator tools and even fewer were aware of their out-of-pocket estimates.

The U.S. government has been trying to make healthcare more transparent and understandable for patients through a variety of new rules it’s implemented in recent years, such as “information blocking” rules that prevent providers from withholding patient data.

  • In 2021, CMS required health systems to notify patients of out-of-pocket expenses and make available tools for estimating prices. 

But how knowledgeable are patients about these initiatives? 

  • Researchers from UC Irvine and the University of Michigan surveyed 423 patients scheduled for CT, PET/CT, or MRI scans in Southern California to find out how much they knew about their out-of-pocket costs. 

Researchers discovered that …

  • Only 11% of patients were aware of their out-of-pocket estimates before getting their scans.
  • Only 17% knew their imaging facilities had price estimator tools.
  • 53% said their illness has been a financial hardship, but only 34% were worried about their out-of-pocket costs for imaging.
  • No patient used the hospital’s estimator tool.
  • Patients were less likely to know their out-of-pocket costs if they had lower income (<$50,000), more financial hardship, and no comorbidities. 

The results show that, two years after out-of-pocket transparency rules went into effect, patients are still unclear on their imaging costs. 

  • This is a major problem due to the high variation in imaging prices that’s been documented in other studies, such as 2023 research that found MRI scans ranging in price from $878 to $3,403.

More outreach could help patients better understand costs. 

  • Such outreach could be made through automated calls or even messages through patient portals prior to their exams.

The Takeaway
The new study – when coupled with recent research on patient reports – shows that radiology still has a ways to go when it comes to keeping patients informed about their imaging exams. Getting patients more involved not only will have economic benefits, but could also help patients participate in their own care.

Should Patients Get Their Radiology Reports?

Posted on by Brian Casey

It’s one of radiology’s great dilemmas – should patients get their own radiology reports? A new review article in JACR examines this question in more detail, documenting shifting attitudes toward data sharing among radiologists, referring physicians, and patients themselves.

In reality, the question of whether patients should get their own reports has been settled by the 2022 implementation of federal information blocking rules that prevent providers from withholding patient data. 

  • But open questions remain, such as the best mechanisms for delivering data to patients and how to ensure they aren’t confused or alarmed by radiology findings.

To that end, researchers conducted a systematic review of studies from 2007 to 2023 on patient access to radiology reports, eventually identifying 33 publications that revealed …

  • 70% of studies found patients expressing positive preference toward accessing their radiology reports, a trend consistent over the entire study period.
  • 42% of studies documented patient difficulties in understanding medical terminology.
  • 33% highlighted concerns about patient anxiety and emotional impact.
  • Physician opinions on report sharing shifted from 2010 to 2022, from initial dissatisfaction to a gradual appreciation of its benefits.
  • Most studies focused on patient opinions rather than those of referring physicians and radiologists, whose opinions were found in only 18% and 9% of studies, respectively.

A major problem identified by the researchers is that radiology reports have medical terminology that isn’t easily understood by patients – this can lead to confusion and anxiety.

  • Communicating findings in plain language could be one solution, but the researchers said little progress has been made due to “resistance from radiologists and entrenched reporting practices.” 

Although it wasn’t mentioned by the study authors, generative AI offers one possible solution by using natural language processing algorithms to create patient-friendly versions of clinical reports.

The Takeaway

Once patients get access to their own reports, it’s impossible to put that genie back in the bottle. Rather than debating whether patients should get radiology reports, the question now should be how radiologists can ensure their reports will be understood without confusion by their ultimate customer – patients.

NYU’s Video Reporting Experiment

Posted on by Jake Fishman

A new AJR study out of NYU just provided what might be the first significant insights into how patient-friendly video reports might impact radiologists and patients.

Leveraging a new Visage 7 video feature and 3D rendering from Siemens Healthineers, NYU organized a four-month study that encouraged and evaluated patient-centered video reports (w/ simple video + audio explanations). 

During the study period, just 105 out of 227 NYU radiologists created videos, resulting in 3,763 total video reports. The videos were included within NYU’s standard radiology reports and made available via its patient portal.

The video reports added an average of 4 minutes of recording time to radiologists’ workflows (± 2:21), with abnormal reports understandably taking longer than normal reports (5:30 vs. 4:15; still statistically similar). The authors admitted that video creation has to get faster in order to achieve clinical adoption, revealing plans to use standardized voice macros to streamline this process.

Patients viewed just 864 unique video reports, leaving 2,899 videos unviewed. However, when NYU moved the video links above the written section late in the study period, the share of patients who watched their videos jumped from 20% to 40%. Patients who watched the videos also really liked them:

  • Patients scored their overall video report experiences a 4.7 out of 5
  • The videos’ contribution to patients’ diagnostic understanding also scored 4.7 of 5
  • 56% of patients reported reduced anxiety due to the videos (via 1% increased) 
  • 91% of patients preferred video + written reports (vs. 2% w/ written-only)

Although not the videos’ intended audience, referring physicians viewed 214 unique video reports, and anecdotes suggested that the videos helped referrers explain findings to their patients.

The Takeaway

We’ve covered plenty of studies showing that patients want to review their radiology reports, but struggle to understand them. We’ve also seen plenty of suggestions that radiologists want to improve their visibility to patients and highlight their role in patient care.

This study shows that video reports could satisfy both of those needs, while confirming that adopting video reporting wouldn’t require significant infrastructure changes (if your PACS supports video), but they would add four minutes to radiologist reporting workflows.

That doesn’t suggest a major increase in video reporting will come any time soon, especially considering most practices/departments’ focus on efficiency, but it does make future video reporting adoption seem a lot more realistic (or at least possible).

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