Report: Patients overpaying for imaging

Payors and patients may be vastly overpaying for some of the most common CT, MRI and mammography exams owing to huge price disparities both within and across regions, according to a quarterly report issued by change:healthcare.

As concern over the growing cost of medical imaging continues, change:healthcare, a Brentwood, Tenn.-based company which publishes healthcare price information, found that plans may pay as much as 700 percent more for exams by not shopping around in their local areas.

The Healthcare Transparency Index sampled data from two million medical claims initiated within consumer-directed health plans in all 50 states. Some of the findings included:

• CT: Payors could save an average of 40 percent on the three most common CT exams (abdomen with contrast, abdomen without contrast and pelvis with contrast). In the Southwest, patients could be charged up to 683 percent more for an exam performed at select institutions.
• MRI: Patients in the Southeast could be charged as much as $2,500 or as little as $560 for a given exam. Overall, change:healthcare estimated a possible 25 percent savings by shopping for lower extremity, brain and lumbar spine exams.
• Ultrasound: Comparing local exam prices could save payors an average of 28 percent, with one locality showing a price range for an abdominal ultrasound from $120 to $700.
• PET: National variations in the cost of PET scans were dramatic, ranging from $1,400 to $2,500 in the Midwest and $3,500 to $4,500 for the same exam in the Northeast.
• Mammography: Payors for the country’s 37 million annual mammographies could save an average of 17 percent by comparing provider prices in their areas.

 
Driven by consumer-directed health plans, the index’s pricing information applies to employer-sponsored health insurance plans. For a company of 15,000, change:healthcare estimated a difference of half a million dollars in comparing the prices of imaging providers.