Increasingly, imaging leaders are observing changes in patients’ behavior. Schedulers are fielding questions about the cost of procedures, while front-office staff, technologists, and even radiologists are being called upon to deliver greater levels of service—spending more time with patients, alleviating concerns, and explaining procedures. These changes point to the arrival of a trend that has been discussed periodically over the past 20 years or so: health-care consumerism. Outpatient imaging, in particular, is primed to feel the effects. Procedures are non-urgent, allowing ample time to select from the multiple providers operating in many markets. Significant price variation, especially between hospital-based and freestanding facilities, also makes outpatient imaging susceptible to the pressures of consumerism. A number of market forces have combined to bring about consumer behavior in patients; five of these forces are particularly important. First, cost shifting: Heightened cost shifting has made patients increasingly price sensitive. Patients are now responsible for a larger portion of their health costs than they have been in years past. The percentage of US workers with high-deductible health-care plans tripled from 2006 to 2010,1 with 30% now responsible for at least the first $1,000 of costs (and up to almost $6,000, for family coverage). Adding this cost shifting to the existence of about 50 million people who are uninsured in the United States makes it clear that patients have a strong interest in seeking care from the provider offering the greatest value. This has led many to shop around for health-care services. Second, patient steering: Payors have long been aware of the huge price differences among imaging services, and they have recently intensified their efforts to steer patients toward lower-cost imaging providers. These efforts don’t end with steering alone. Some insurers have begun to offer patients cash incentives (typically $50 to $200) when they select lower-cost providers for particular services.
Two large payors, Anthem Blue Cross Blue Shield and Harvard Pilgrim Health Care, have deployed these types of programs, encouraging patients to go online or call a toll-free number and compare prices for certain ambulatory procedures. In fact, Harvard Pilgrim Health Care’s Save-On program even pays $10 to patients who simply make the call, not even requiring the patient to select the lower-cost provider (Table 1). Third, social media: Social-media platforms—Facebook, Twitter, and especially the consumer-review site Yelp—all allow patients to shop virtually for providers. Increasingly, these sites have become places where patients share information on health-care providers, writing reviews about experiences both positive and negative.
Survey² data underscore the spread of this trend: a quarter of adults are using social media to post information about their health-care experiences, while 42% access these reviews (Figure 1). These numbers show the importance of ensuring that every patient interaction is a positive one. Reviews are shared instantaneously with millions of people, affecting providers’ online reputations. Fourth, patient-satisfaction scores: Beyond reputation, patients’ perceptions of their experiences with particular providers are now tied to reimbursement. While CMS started administering the Hospital Consumer Assessment of Healthcare Providers and Services (HCAHPS) survey in 2006, on October 1, 2012, its results became part of the measures included in value-based purchasing, tying patient satisfaction directly to payment. The 27-question HCAHPS survey is submitted to patients after discharge and asks about their experiences: How responsive was the staff? Would the patient recommend the hospital? While these categories focus on the inpatient experience, ambulatory experiences are likely to become part of the system. Moreover, it also is probable that commercial insurers will follow the lead of CMS, introducing comparable pay-for-performance initiatives that encompass patient satisfaction. Programs that focus now on improving the outpatient experience will be well prepared when reimbursement hinges on performance. Fifth, choice of provider: The patient’s choice of provider is staunchly protected within accountable-care organizations (ACOs), underscoring the importance