Price transparency efforts and healthcare consumerism update at RSNA

December 14, 2020
by John W. Mitchell, Senior Correspondent
Policymakers over the past decade have tried to help patients control their health spending. An RSNA session this month, titled "Price Transparency: Is it Hype or Reality?" showed little success in this objective, with three physicians experienced in healthcare economics breaking down the challenges.

One is patient price sensitivity, which Dr. Yoshimi Anzai, a neuroradiologist and associate chief medical quality officer at University of Utah Health Care, likens to opening a restaurant menu with no prices. She says part of the problem lies in the wide price variation for many healthcare services, including imaging. An abdominal and pelvis CT with contrast, for example, can vary from $250 to $2,200, depending upon location. High deductible health insurance plans have increased out-of-pocket costs by 63 percent in the past five years, with premium increases of 19 percent. Meanwhile, wages have only increased by 11 percent. “That is not sustainable,” said Anzai.

Despite efforts to push hospitals and clinics to publicly disclose their prices, 14% of patients incur 76% of the bill for costly services, such as cancer and cardiac care, with patient price sensitivity at only about 11%, according to Anzai.

She also shared a survey that asked patients to rate a trade-off between lower quality and cost to services that promised higher quality and cost. Two-thirds of patients chose lower quality/cost for CT and MR, but higher quality/cost for orthopedic surgery. “It reminds me that patients feel there is not a lot of difference in terms of quality for CT and MR," she said.

But another survey published in The Harvard Business Review rates out-of-pocket costs among the top items that matter most to patients. To that end, the University of Utah, rolled out a patient price calculation tool in 2016 that receives about 5,000 visits a month to the website for shoppable services. "The price transparency for healthcare services like surgery or imaging or endoscopy may have a long way to get where we need to be, but in terms of price transparency, it has improved," said Anzai.

A second speaker, Dr. Ruth Carlos, professor and assistant chair of clinical research in radiology at the University of Michigan, urged the need to mitigate social determinants of health (SDoH) to control healthcare spending. These include economic stability, housing and food, education and the healthcare system, and can affect the ability of patients to buy medicine or have transport for follow-up appointments, following discharge.

She said that the Patient Advocate Foundation found in a secret shopper survey that 67 percent of insurers give “inconsistent” answers about patient costs. She advocates for payment models alternative to out-of-pocket. “Financial burden leads to higher out-of-pocket costs, higher out-of-pocket leads to lower medication adherence, it worsens their physical and mental health, and patients who have less than 12 months of financial reserve report increased symptoms and lower quality of life. Increased debt and bankruptcy … also increased mortality.”

The final speaker, Dr. David Seidenwurm, radiologist and medical director at Sutter Health, said that the current pandemic has effectively had a chilling impact on any hoped-for reform in healthcare cost delivery in the near-term, and that reducing healthcare percentage of GDP and insurance market reform seems less important given that there may not be a GDP or insurance market in 2021 due to COVID-19.

"We’ve noticed, and I think this has been documented around the country, a shift to a lower volume of more complicated patients,” said Seidenwurm. “To some degree, this is good. The decrease in emergency room use seems to be disproportionally in the category of potentially avoidable visits.”

He also spoke about radiology’s place in the emerging financial delivery model of population health management and says mining patient experience (satisfaction) data could help radiologists increase perceptions of value among consumers (patients).

“We can hope, perhaps, that there will be a light at the end of the COVID tunnel and that we can go back to improving population health in the traditional way and use the knowledge we gained in the pandemic,” he said.