Academic radiology practices lose $1M per year to exam no-shows

Academic radiology practices offering run-of-the-mill exams like mammography, MRI and CT are likely losing around $1 million per year to missed imaging appointments and no-shows, according to a study published this June in Current Problems in Diagnostic Radiology.

Across all medical specialities, no-shows represent not only a missed opportunity for care but also a missed opportunity for compensation, first author Rebecca J. Mieloszyk, PhD, and colleagues at the University of Washington wrote in CPDR. But in some departments, that lack of revenue hurts more than in others.

“A costly form of specialty medicine, radiology likely sustains a greater amount of uncaptured revenue per patient visit than primary care or other practices due to patients not keeping their appointments,” Mieloszyk et al. said. “Even in cases where an appointment is filled with an inpatient or standby patient, there are sometimes lost costs due to staff preparatory work, such as insurance authorization, scheduling time and protocoling.”

To assess the financial burden of missed appointments in radiology, the authors turned to an average-sized, university-affiliated academic medical center that churns out around 200,000 exams a year. The team evaluated no-shows for six exams they believed would have the highest missed appointment rates—mammography screening bilateral, MRI brain with contrast, CT chest and head without contrast, abdominal ultrasound, and breast bilateral ultrasound— in the context of 2018 Medicare fees.

In a model designed to represent the majority of larger radiology practices in the U.S., Mieloszyk and her co-authors found that uncaptured revenue for brain MRI, abdominal ultrasound and mammography screenings alone each exceeded $100,000, totaling nearly $700,000 of missed payments for those exams alone.

Uncaptured revenue for breast ultrasound rose to around $15,000 per year, according to the study, while mammography screenings topped out at $350,000. In total, Mieloszyk and colleagues wrote, annual uncaptured revenue due to radiology no-shows approaches $1 million. 

“For context, this missed revenue could cover the purchase of a new 3T MR scanner each year,” the authors said.

One of the greatest burdens was reflected in mammography screenings, which are some of the cheapest scans a physician can order. But, likely since patients are aware of their cost and commonality, the exams are often canceled and can become a major money pit.

“Results of this exploration demonstrate that the greatest annual uncaptured revenue need not correspond to the most performed or the most expensive exams,” Mieloszyk et al. wrote. “Mammography screening, one of the lowest-cost exams, can in fact impose a large burden of uncaptured revenue.”

In the future, the researchers said, quality improvement projects could focus on integrated modified scheduling or patient reminder systems to improve the numbers.

“Our projections only take into account direct exam revenue and underestimate the burden of pre-work activities,” they wrote. “These tasks include the initial scheduling of the patient, insurance pre-authorization, patient reminders and protocoling of the exam. The time that is dedicated to these activities cannot be recouped.”