The cost of imaging: Why should consumers care?

I've had my fair share of imaging procedures for a variety of not-very-alarming issues. I recently had an MRI to look at what my neurosurgeon affectionately calls my "crappy disc." And since I have a high-deductible health plan, I thought a lot about how much it would cost.

Note that I said I thought about the cost of the procedure. I didn't actually do anything about it.

Why? Because the neurosurgeon who takes care of my crappy discs and cranky back has just opened an imaging center one floor down from his office. And it's really pretty.

In fact, I assumed the procedure would cost more at the well-decorated free-standing imaging center than it would at the local hospital. (I've since learned I was wrong about that--but I only bothered to find out after I had the test done--more on that below.)

Now, a couple of weeks ago, I got in trouble for a throw-away line in a column about engaging patients in their own healthcare (Tech can help people get healthy, but can it make them want to?).

Payers, I wrote, have a particular interest in keeping the costs of healthcare down under the current fee-for-service payment model. Then, thinking I was being clever, I wrote: "And don't get me started on high-deductible health plans: The vast majority of patients do not care one whit how much a procedure costs, even if they're paying for a chunk of it out of their own pocket."

Readers took me to task for that gross generalization.

"As a physician, I see out-of-pocket costs affecting decisions on a daily basis," wrote one commenter.

Another doc wondered if I live in a parallel universe.

"Every day in our small family practice office, I see patients literally haggle over the cost of their copay (be it $20 or $30), refuse important diagnostic and/or preventive tests because of a high deductible and [are] unable to fill life-saving prescriptions because they need the money to pay for housing, food and clothing. At least the ACA has taken care of the cost preventive tests for those with insurance. People care deeply about how much a procedure costs. They care about the cost of everything these [days], and the cost of healthcare is just one more bill to them."

I stand chastised.

So let me state for the record that yes, I understand I am extremely lucky that I have health insurance and that I can afford the premiums, deductible and copays. But as the commenter pointed out, the Affordable Care Act will get more people onto the rolls of the insured. And what are we doing to counsel and educate them about the cost of high-ticket procedures such as MRIs?

Once again, insurance companies are leading the way.

Cigna unveiled a similar tool for its customers in February that allows patients to search costs for 200 common medical procedures and estimate prices for specialists, doctors and hospitals based on their coverage

UnitedHealthcare just launched a price comparison tool called mHealthcare Cost Estimator, and WellPoint has offered similar price comparison tools to some of its customers since 2009.

(I learned that freestanding imaging centers aren't as expensive as I thought while playing around with UnitedHealthcare's tool, by the way. You learn something new every day.)

My point is that if the healthcare industry is going to figure out a way to cut costs, it is either going to have to break me of my life-long habit of being passive about healthcare decisions or it is going to have to do it without me. And even if I do live in a parallel universe, I swear I'm not here by myself. 

What else can we do to turn patients into educated consumers? When patients in your exam room do raise questions about the price of procedures, what do you tell them? Are you pointing them to online price calculators, telling them to call around to different imaging providers to get the best price, counseling them that diagnostic procedures today are a lot less expensive than dealing with a health crisis tomorrow?

Please send me a postcard from your universe in the comment box below. - Gienna


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