The use of “financial coping strategies” is common among patients unable to shoulder high out-of-pocket costs for advanced imaging, according to new research published Monday in JACR.
About 35% of patients participating in a recent survey said they have used such tactics. Common responses to a hefty radiology bill might include decreasing household spending (22%), dipping into savings for medical expenses (15%), or taking on additional debt (15%).
Researchers believe these numbers signal the importance of screening individuals for financial insecurity to ensure they are not forgoing care because of costs.
“Advanced imaging remains one of the most frequently ordered diagnostic tests, yet the financial burden associated with advanced imaging is rarely evaluated,” Gelareh Sadigh, MD, a neuroradiologist and assistant professor with Emory University’s School of Medicine, and co-authors wrote Jan. 17. “Radiology practices are potentially well positioned to integrate patient-level screening for financial fragility to standardize this care process,” they added later.
Researchers conducted their anonymous survey among patients undergoing outpatient CT or MRI exams at Michigan Medicine in late 2018. All told, Sadigh et al. collected 671 responses from patients treated at 1 of 5 imaging clinics. Of those, 22% said they worried about paying for advanced imaging while 17% recalled being briefed about their expected out-of-pocket costs.
The study also assessed individual’s level of financial worry using the Comprehensive Score for Financial Toxicity (COST) tool, rating such concern on a scale of 1-40 (with lower scores denoting higher financial burden). Patients polled logged a median score of 28, compared to a tally of 22 among cancer survivors in one 2016 study.
Controlling for demographic factors, higher financial worry (or a lower COST score) was associated with higher imaging out-of-pocket concerns. Imaging OOP worry was found to exert the largest impact on patients’ use of financial coping mechanisms, while being informed of their anticipated cost sharing ahead of time did not have an effect. About 15% of respondents said they had at least one episode of “care nonadherence” over the past three months, including delaying filling prescriptions (9%) or taking fewer pills than prescribed (7%). Having a chronic illness also appeared to increase one’s chances of resorting to financial coping actions.
As far as screening for such concerns, 67% said they were comfortable answering questions about their monetary situation, and 69% would discuss the impact of care costs on their finances. About 66% said they’d be OK with having these conversations in an outpatient imaging setting, but only 18% would want to discuss out-of-pocket costs on the same day as the encounter.
“A large minority declined to answer financial questions, which may have incompletely captured financial burden in this population,” the authors cautioned. “However, we suggest that nonresponders may experience higher rates of financial burden and our estimates represent the minimum.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.