Health care can be a maze. This is one in a series of articles to help manage costs while providing members with the best health outcomes.
There has been a lot in the trade press lately about imaging, especially related to place of service. Specifically, some health insurers have stopped paying for outpatient imaging services performed in a hospital setting.
Until recently, imaging centers could be described as either in-hospital or free-standing. However, it’s become tricky because many free-standing facilities now belong to hospitals. Today, the best way to differentiate between the two types of imaging centers are to describe them as “hospital-affiliated” or “independent.” (Note that when people or health plans say “free-standing” they are usually referring to an independent facility.)
The quality of the results and subsequent health outcomes have been proven to be the same at both types of imaging centers. However, there is one very big difference: Cost. Hospital-owned imaging centers are 3 to 10 times more expensive than independent imaging centers.
One reason independent facilities cost less and provide better service is that they specialize in imaging services. They also schedule their imaging equipment more efficiently, booking all the available time slots, conveniently including weekends and evenings. They focus only on your imaging procedure.
Hospital-owned imaging centers are typically more expensive mostly because hospitals have negotiating power. If people choose to go to independent, free-standing centers, hospitals will start to bring their prices down.
It is almost impossible to know from the look of it whether a facility is independent or hospital-owned. When people call to make an appointment, they should ask who owns the facility. If it is owned by the local hospital, it is usually a higher cost site. Depending upon the health plan, it likely costs more when they choose a hospital. If people need help, their health plan can help them find the most cost-effective site.
While a doctor might recommend an imaging facility, patients can go to any facility that’s covered by their health plan. Most doctors understand the cost differences and will help their patients get care from the most cost-effective place. They know that for the vast majority of imaging tests, independent sites that are accredited by the American College of Radiology provide the same and sometimes better quality of care than a hospital location.
Dr. Bartley Bryt is Chief Medical Officer at Brighton Health Plan Solutions (BHPS), an innovative health care enablement company with several industry-leading products for labor and the public sector, including MagnaCare and Create, a new marketplace of health systems and service platform.