More on Reimbursement

Why do patients often opt for pricier MRI tests? They don't shop around

Only a small number of consumers use price transparency tools, and physicians have narrow referral networks.

Jeff Lagasse, Associate Editor

One might think that patients, empowered as consumers, would opt for the lowest prices, but that's not always the case -- and particularly for MRIs, it's rare that a patient researches costs, according to a report from the National Bureau of Economic Research.

Patients often opt for higher-priced providers, and part of the reason is that fewer than 1 percent use price transparency tools to shop around. Physicians themselves often play a role as well, referring patients to hospitals for MRIs, where the cost is typically greater.

An interesting metric: On the journey from their home to their chosen provider, consumers on average pass six lower-priced providers.

The researchers focused primarily on lower-limb MRI scans because they're among the imaging services that are easiest to price compare. And if consumers did more of that, the savings would be substantial. Stopping at one of those six lower-cost providers would result in 27 percent lower out-of-pocket costs and 40 percent less insurer spend, the study found.

Those physician referrals might be partially culpable for consumers' disinterest in MRI price shopping. The research found physicians' suggestions carry more weight with patients than the potential for out-of-pocket cost savings, and most physicians send patients to a relatively small pool of imaging locations.

Looking specifically at orthopedic surgeons, researchers determined that 79 percent of all orthopedic referrals go to a single imaging provider. Non-orthopedic doctors who are vertically integrated with a hospital are an influence as well, since hospital-employed physicians are naturally more likely to refer someone to a hospital.

That in turn raises the total cost of an MRI by 36.5 percent, the report found, and 31.9 percent more is paid by the patient.

The solution for consumers, they said, is to break from these established referral pathways, which would reduce both out of pocket costs and overall MRI spending. Policy changes could also be uszed to incentivize doctors to make more cost-efficient referrals.

Though the study focused primarily on lower-limb MRIs, its authors said the results indicate consumers likely won't price-shop for other, more complicated medical services or procedures.

Twitter: @JELagasse
Email the writer: