Emergence of Consumerism in Imaging

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Hurried along by economic hard times, consumerism is making an impact on diagnostic imaging choices, and savvy practices are responding

As Bob Dylan once sang, “You don’t need a weatherman to know which way the wind blows.” Neither does it take an expert to see that the US primary care delivery model is on the verge of experiencing a tectonic shift. The weakening economy has led to an increase in the ranks of the uninsured; a recent article¹ in Health Affairs predicts that the uninsured population of the United States (currently estimated at 47 million) will increase by at least seven million, or 15%, in 2010 alone. The uninsured, however, aren’t the only ones experiencing reduced access to services: with the advent of health savings accounts and high-deductible insurance policies, even consumers with health insurance are facing a new set of challenges when it comes to selecting and paying for primary care.

Jeff Goldsmith, PhD, is president of Charlottesville, Virginia-based Health Futures, Inc, a company specializing in corporate strategic planning and in forecasting future health care trends. He says, “The biggest change we’ve seen is the gradual stripping away of the protection of health insurance. That’s clearly been at work in this most recent recession: We’ve seen a downturn in hospital admissions for elective procedures, a downturn in surgeries, and downturns in prescriptions filled and in physicians’ offices opening. I’ve never seen all those things happen at once, in the 35 years I’ve worked in the field.”

Goldsmith says, though, that it is not as simple as health insurance becoming less comprehensive, so consumers are becoming pickier shoppers. He points to a number of trends that have created the current perfect storm of consumer-driven health care. “I think baby-boom women get a lot of the credit here,” he says. “They really originated this movement in the 1970s by demanding that care to them be provided on their terms, according to their needs. To me, consumerism is really synonymous with the woman’s ascendance as her own, and her family’s, chief health officer.”

Goldsmith also cites the democratization of information as a key factor in the growing impact of consumerism on health care in general, and on radiology in particular. This sentiment is echoed by Melanie Haymond, marketing director in business development for Epic Imaging, Portland, Oregon. “I think this really started five or six years ago, when consumers began to realize they had a choice,” she says. “Of course, there are limitations on how much you can educate yourself using the Web, but regardless, patients were walking into physicians’ offices armed with reams of Internet research. For the first time, they really wanted to have a voice in where their procedures would be performed.”

Harley Hammerman, MD, CEO of Metro Imaging, St Louis, Missouri, concurs: “Before, their physicians were consumers’ only resource. Now, there’s an unlimited amount of material available on the Internet, for better or for worse. For a while now, patients have been experiencing higher and higher deductibles, plus rising copayments; in recent times, we’ve seen more and more patients who don’t have insurance at all. Patients are much more selective about what they get and where they get it.”

The New Patient

For imaging centers, the notion that the patient needs to be catered to as aggressively and intelligently as the referring physician is a game changer. It also reveals how much the patient has changed in the past decade. “We realized that patients are using the Internet to educate themselves, so we decided to maximize our Web-site opportunities by making sure we had keyword optimization and would pop up often for those consumers,” Haymond says. “We believe, at this point, that you cannot have a patient-service offering without making some statement about price and cost. The fact is, consumers are driving the industry, in the past five or ten years, in a way that we just have not seen.”

Hammerman’s practice has taken similar measures to appease the price-conscious patient. “We have a department that helps make patients aware, upfront, of what the exam will cost them before they come in,” he says. “Many patients don’t understand that they’ve got a deductible or a copayment. We help them decide whether they really want the exam.”

A few years ago, this type of full disclosure might have been looked upon as an unwise business move. Back then, the party line