Many of modern medicine's miracles rest in MRIs and CT scans, and the price a patient pays may vary widely depending on where those tests are performed.

Free-standing clinic officials say the era of patients going wherever a doctor sends them for such tests is about to end. Regardless of how convoluted insurance might make the cost to the patient, they say their rates for diagnostic scans are lower than those at hospitals.

Some experts say price isn't the only thing a patient should inquire about before having a diagnostic test. Not all machines are alike in the clarity they provide or the complexity of the medical condition they can take on.

It's wise for a patient to talk the matter over with the doctor before undergoing a scan, said Dr. Dave Filipi of Blue Cross Blue Shield of Nebraska.

"Clearly it's a reasonable discussion to have," Filipi said.

Hospital officials at Methodist Hospital and the Nebraska Medical Center don't deny the price differences. They say they charge higher prices for diagnostic tests than free-standing clinics to help cover the overhead associated with being open 24 hours a day, every day. They also say their equipment may provide more data or better images than those at many free-standing clinics.

The battle for a share of MRI, CT and ultrasound business is evident in the fact that two free-standing diagnostic clinics in Omaha have closed within the past couple of months — Dodge Street Radiology at 40th and Dodge Streets and Professional Imaging Omaha in the Regency area.

Meanwhile, those at two remaining free-standing clinics, Village Pointe Imaging Center and Nebraska Health Imaging, say they see increasing numbers of patients who understand that it pays to shop around.

"Patients are becoming more savvy," said Kristen Nicholson, spokeswoman for Village Pointe Imaging Center, 302 N. 168th Circle. "They're calling around and price-checking."

Aida Allen, an Omaha interior decorator, said it was pain, not price, that compelled her to go to Village Pointe Imaging Center. A chiropractor referred Allen, 42, to the center for an MRI of her back.

"I was willing to go anywhere," Allen said. Her thought as she struggled through the pain last year was: "When you're in pain, you just want to find a way to get better."

As it turned out, she liked Village Pointe's open MRI, which claustrophobic patients prefer, and found the customer service excellent.

The competitiveness in diagnostic imaging is undeniable. Free-standing clinics that lobby Methodist Hospital-affiliated doctors to send patients their way will receive a letter from Methodist Physicians Clinic. The letters say it's "against our policy to allow outside imaging company vendors to market" to Methodist Physician Clinic staffers.

Price quotes for self-paying patients (those who don't use any kind of insurance) back up free-standing clinics' claims. The out-of-pocket fee for people with insurance would, of course, be much different, depending on their plan.

For self-paying patients at Nebraska Health Imaging, an MRI of the knee or brain without contrasting dye would cost $670, and a CT scan of the chest, also without contrasting dye, would cost $375. Nebraska Health Imaging is at 7819 Dodge St.

At Village Pointe, an MRI of the knee or brain without contrast would typically cost $700, and a CT scan of the chest without dye would cost $400. Both businesses say they provide discounts if self-payers pay their bill the day of the procedure.

Methodist officials said a similar MRI of the brain at their hospital would cost self-payers $1,170, and of the knee, $951. A CT scan of the chest, without dye, would cost the self-payer $976.

At the Nebraska Medical Center, an MRI of the brain without dye would cost a self-payer $2,295, of the knee $2,486 and a CT scan of the chest $1,671.

The Nebraska Medical Center and Methodist Hospital say they provide financial assistance in some instances.

The free-standing clinics' prices include the professional fee, which covers the radiologist who reviews the scan, while that fee generally is charged separately at hospitals. That fee can be $100 or considerably more.

Nebraska Medical Center officials said their charges are higher even than Methodist's because their hospital is one of two trauma centers in the city. Creighton is the other. Trauma patients, who have suffered gunshot wounds or been involved in accidents, frequently are uninsured and frequently don't pay for their care, said Nebraska Medical Center spokesman Paul Baltes.

"So why don't people come to us?" asked Kevin Ordway, vice president of operations at Nebraska Health Imaging. "Number one is, the hospitals absolutely control their physicians."

By that, Ordway meant that hospital-employed or hospital-affiliated physician groups tend to refer patients to their particular hospital. It only makes sense that they would do so. "When physicians are owned (employed) by a hospital, their job is to support that hospital," Ordway said.

No doctor or hospital administrator contacted for this story said they're aware of hospitals giving bonuses or kickbacks to doctors who refer to their diagnostic services.

Hospital administrators say it's understandable that a hospital-affiliated doctor would have a diagnostic scan done within that system. The scan will be done consistently with prior scans done there. And Methodist officials said the report from the scan and the image itself will be placed into a Methodist patient's electronic chart.

Dr. Craig Walker, chairman of radiology at the Nebraska Medical Center, said some complex scans require specialized training by technologists and radiologists. For instance, his has the technology and staff training to do a cardiac MRI. Outpatient centers typically don't offer that kind of MRI.

Asked if he would allow family members to receive scans at free-standing clinics, Walker said: "It depends on what exam was being done."

Walker said he prefers closed MRIs, which generally offer higher strength and better images, to open MRIs, which are often used by claustrophobic patients and large patients who struggle to fit into the more narrow, enclosed device.

Diagnostic imaging is an important money-maker for hospitals. Hospitals tend to lose money on some services, such as the emergency department, where no patient can be turned away.

Brian Baker, president of Regents Health Resources, a Tennessee-based consulting firm, said diagnostic imaging has replaced surgery as hospitals' best contributor to the bottom line.

"It's lucrative on its own, but when it's rolled into the overall hospital business, it helps a hospital to remain solvent," he said. "It offsets losses."

The number of scans has risen dramatically. Federal data indicate the number of diagnostic tests covered by Medicare went up sevenfold from 1995 through 2009.

Consequently, the availability of remarkable technology has contributed to the financial burden weighing on the nation's health-care system.

Dr. Donald Frey, Creighton University vice president for health sciences, said diagnostic imaging has replaced exploratory surgery in many cases. At the same time, when doctors overutilize MRIs and CT scans, or cave in to patients' demands that they undergo those tests, that drives up health care costs.

"Diagnostic imaging is very, very expensive," Frey said. He said physicians should give patients choices that consider cost, convenience and quality. As for the quality of free-standing diagnostic centers, Frey said, "The technology is good across the board."

Contact the writer:

402-444-1123, rick.ruggles@owh.com

« Live Well - Health & Medicine

Share