The rise of healthcare costs is a major issue for Americans with everyone from hospital administrators to patients feeling the impact. Computed tomography (CT) cost of care is not immune. But what is the current status of the CT industry, what is causing the biggest impact, and how can departments across the United States start reducing their costs.
CT Departments and Cost
According to Yoshimi Anzai, MD, at the University of Utah, the rising costs of healthcare are forcing CT departments to change how they approach finances. And the costs associated with CT departments have largely been the responsibility of the administration and finance departments.
In her 2018 Radiological Society of North America (RSNA) conference speech, Dr. Anzai said, “Health insurance used to cover everything. But now, many employers have identified healthcare as being a huge cost to them, and they are shifting costs to the patients.”1
The reliance on patients to pay for healthcare out of pocket is causing concern among healthcare professionals.
The 2018 IMV Market Outlook Report2 survey results show that one of the top 5 things CT departments are concerned about is the impact of high deductible insurance plans.
Given that the 88.7 million CT scans were performed in 2018 (an 8% rise from 2016), payment responsibility is shifting from insurance companies to the patient. The impact of high deductible insurance plans is likely to be felt for the foreseeable future as 70% of respondents anticipate their workload to grow.
So how can CT departments reduce the cost of care while managing an increase in workload?
Taken from Dr. Anzai’s suggestions and the IMV Market Outlook Report, here are 3 ways CT departments can reduce the cost of care.
1. Increase CT Cost of Care Awareness
In her speech at RSNA, Dr. Anzai stresses the importance of CT departments becoming more educated on all cost-related changes from payment reform issues to reimbursement as well as changes in the health insurance landscape.
As the amount of cash-paying patients increases, the more important it will be for CT departments to be able to itemize their billing statements.
While this has not been common practice until recently, a 2016 study published in Academic Radiology3 dissected the costs of abdomen and pelvic CT scans. The breakdown of costs are as follows:
- Radiologist interpretation: 40.1%
- Other personnel, including the scheduler, technologist, nurse, pharmacist, and transporter: 39.6%
- Materials: 13.9%
- Space and equipment: 6.9%
While the cost differed between the emergency room and inpatients (13% and 31%, respectively) as compared to outpatients, 80% of the direct cost was related to labor. This means CT departments and hospital administrations must look at ways to streamline workflows, improve communication across departments and find less expensive alternatives when possible.
2. Improving Communication
Inefficiencies are expensive. When it comes to healthcare, it means more than $11 billion a year and this equates to 30% of the annual spend on healthcare in the United States.4
In the IMV report, one of the concerns indicated by CT departments was workflow. The issues surrounding workflow include getting the correct order from the referring physician the first time, reducing overuse by the emergency department, and standardizing imaging protocols.
Communication between doctors and radiologists has been an ongoing issue for decades.5 Attempting to address the miscommunication, one 2016 study created a standard radiology request form for X-rays, CT scans and Ultrasounds. For each modality, 50 cards were disseminated over a 2 month period of time.
What the study found was even with a 100% response rate, the request cards were still not filled out in a sufficient manner. They lacked relevant history, information about clinical information, etc.
As a result, the researchers recommended a meeting between the Medical Assessment Unit, the IT department and representatives of the radiology department to discuss how to improve the current practice.6
3. Reducing CT Overuse In the Emergency Department
Another concern indicated in the IMV report was CT overutilization, especially in the emergency department.
In 2016, a study was released that involved a 3-part intervention on the rate of CT ordering in the emergency department. Through the use of an initial 30 minute PowerPoint presentation, subsequent material distributed via email and monthly feedback, researchers were able to reduce the amount of CT scans by 10% in three states (California, Oregon, Washington).7
Awareness and Education Reduce Cost of Care
The U.S. healthcare system is currently one of the largest industries in the U.S.8 With the increase in cash-paying patients and the heavy reliance on radiology for diagnoses, CT departments are being called on to improve efficiencies and understand how costs impact their patients. To accomplish this, communication, education, and awareness are the first steps.
- Bassett, Michael. “Understanding Economics Helps Deliver Value in Health Care.” Radiological Society of North America News. December 18, 2018. https://www.rsna.org/news/2019/january/economics-deliver-value-health-care. Accessed February 22, 2019.
- 2018 CT Market Outlook Report. IMV Medical Information Division. November 2018. https://imvinfo.com/product/2018-ct-market-outlook-report/ . Accessed February 22, 2019.
- Anzai, Yoshimi et al. “Dissecting Costs of CT Study: Application of TDABC (Time-driven Activity-based Costing) in a Tertiary Academic Center.” Academic Radiology. Volume 24, Issue 2, 200-208. https://www.academicradiology.org/article/S1076-6332(16)30343-9/fulltext . Accessed February 22, 2019.
- “Top 5 Inefficiencies in Hospital Operations.” Beckers Hospital Review. February 18, 2016. Available online: https://www.beckershospitalreview.com/quality/top-5-inefficiencies-in-hospital-operations.html. Accessed February 22, 2019.
- Fisher, Harry, MD. “Better Communication between the Referring Physician and the Radiologist.” Radiological Society of North America News. March 1, 1983. Available online: https://pubs.rsna.org/doi/abs/10.1148/radiology.146.3.845. Accessed February 22, 2019.
- https://www.oatext.com/Adequacy-of-clinical-information-on-radiology-request-cards-from-medical-assessment-unit-Clinical-Audit.php#Article. Accessed February 29, 2019.
- Miller, G., Totten, V., Denson, D., Wishka, C., Whitlow, K., & Tamayo-Sarver, J. (2017). “A program of education and performance feedback reduces CT ordering in the emergency department.” The American Journal of Emergency Medicine, 35(9), 1363-1364. Available online: https://www.deepdyve.com/lp/elsevier/a-program-of-education-and-performance-feedback-reduces-ct-ordering-in-VD1hyBwclA?articleList=%2Fsearch%3Fquery%3Dreduce%2Bct%2Bin%2Bed. Accessed February 22, 2019.
- Thomspon, Derek. Health Care Just Became the U.S.’s Largest Employer. The Atlantic. January 9, 2018. Available online: https://www.theatlantic.com/business/archive/2018/01/health-care-america-jobs/550079/. Accessed February 22, 2019.