Financial Impact of MRI Anxiety
The financial impact of canceled MRI examinations is substantial. A 1993 study in the U.S. found an estimated “annual net loss of $65,250,000” due to canceled MRI examinations37. Worldwide, there is a 2% worldwide cancellation rate due to claustrophobia, resulting in nearly 2 million MRI exams being canceled due to claustrophobia and an estimated loss of €1 billion Euros or approximately $1.4 billion U.S. dollars37. Canceled MRI exams also have a financial impact on imaging centers and patients, and contribute to increased healthcare costs and potentially the pay-rates of technologists23,38,39.
The financial impact of canceled MRI exams on patients, technologists, imaging departments and overall healthcare costs is somewhat complex with many contributing factors12,23. Some of these factors include insurance reimbursements, medical legislation and regulations, and operating costs12,39,40. To gain a better understanding of the complexities, let’s explore of the economics of MRI.
The cost of running an MRI machine is dependent on how long the machine has been in service12,38. The initial cost of buying and installing an MRI machine can be more than three million dollars and it takes time to recapture the initial investment38. The newer the machine the higher costs, with an average cost per exam estimated at $100–$40012. This cost is also influenced by where the exam is performed, with operational costs of a free-standing imaging center being considerably higher than in a hospital12. The cost per exam is also dependent on how many patients are seen; thus, any reduction in the number of daily exams increases the costs12. Research has concluded that no-shows and canceled MRI appointments decrease the number of exams performed and contribute to increased operational costs (averaging $2,400 per day) and, ultimately, higher healthcare costs12,38,41.
The insurance industry has had a significant impact on the economics of MRI departments. These changes have had a financial impact on the operating costs of imaging departments and overall healthcare costs40. The popularity of using advanced imaging such as MRIs increased dramatically in the 1990s and insurance companies took notice40. Insurance companies then began promoting the current trend, aiming to decrease their costs by reducing the number of advanced imaging tests performed. This trend has been assisted by Radiology Benefit Management programs or RBMs. RBMs require preauthorization for any advanced imaging study by insurance companies before they are performed40. As a result, there has been a consistent reduction in the number of MRIs performed in areas where these programs are prevalent40.
This trend contributes to a reduction in the number of MRI exams performed and equates to decreasing an imaging department’s patient volume revenue12. When there is a reduction in the number of exams performed in a given day due to RBMs and/or anxiety, the cost of each exam increases due to costs associated with operating the machine38. For example if the operational costs of an exam is $100 per exam and there are 10 exams scheduled that day, and one MRI is canceled due to anxiety or a no-show, then the operational costs of the other exams completed goes up to $110 per exam, subsequently increasing the overall operational costs38. This creates a need for imaging departments to become efficient in completing every exam12.
Substantial reductions in the reimbursements insurance companies will pay for MRI exams along with higher insurance premiums have contributed to rising healthcare costs12. In the late 1980s, the average reimbursement for MRI was approximately $1,000 per exam compared with the current reimbursement rate of approximately $29840,42. The economic impact of canceled MRI exams expands beyond medical facilities and has affected radiologists as well as they have seen a reduction in reimbursements for their professional services12. Currently (2021), there is a another proposed 12% reduction in the professional component reimbursement in the U.S. and 8% globally43. This reduction in exam volume and radiologists’ readings along with the reduction of insurance reimbursements may cause a domino effect. Radiologists may charge more for their professional services in order to make up for the difference in revenue, which contributes to an overall increase in healthcare costs12. Consequently, the increase of advanced imaging techniques such as MRI has been cited as a contributing factor to higher insurance premiums12,40. One of the ways to reduce healthcare costs, imaging facility overheads, and insurance premiums is to ensure efficiency in the MRI department.
The trend to reduce the utilization of advanced imaging extends beyond private insurers and into government programs. Over the last three decades, increasing government regulations regarding the use of MRIs have played a role in increasing the operational costs of imaging centers12,24. The federal government has joined private insurance companies by reducing Medicare and Medicaid reimbursements via the Deficit Reduction Act of 200524. The Deficit Reduction Act (2005) drastically reduced MRI exam reimbursements24. For example, the rate of reimbursement for a brain MRI for a free-standing imaging center was $995 in 2005; following enactment of the Deficit Reduction Act, this reimbursement was reduced to $506 for the same exam, with the current rate being $29840,42. This is approximately a 50% reduction in reimbursements, which in turn increases the cost per exam because the fixed costs associated with performing an MRI remain the same24,40. The most recent reductions occurred between 2007 and 2019; of all imaging modalities, MRI sustained the largest reduction in Medicare and Medicaid reimbursements by a whopping 64%44.
Prematurely canceled MRI exams not only affect healthcare costs in the United States, but also in countries that practice socialized medicine. Worldwide, the long wait time for MRI procedures has been a major challenge for many imaging departments45,46. Reducing wait times for MRIs has been an on-going topic for international healthcare policymakers46. In these healthcare systems, long waiting lists for advanced imaging tests such as MRI may cause delays in medical treatments, resulting in poorer healthcare outcomes45,46. Hence, increasing the completion rate of this exam may have a positive effect on increasing imaging efficiency and thereby help control national healthcare costs in addition to increasing the availability of this imaging modality to more patients.
The financial impact of canceled MRI exams also extends to patients. Although the financial impact on patients is not as high as on imaging departments, it still affects their bottom line. It is important for us technologists to realize that when a patient cannot complete their exam, it doesn’t just affect the imaging department’s bottom line but also the patient’s and possibly yours too. The most obvious financial cost to patients is transportation to their MRI appointment. When their exam is prematurely terminated, their transportation cost essentially doubles23. Transportation costs can also be considered a contributing factor in the increasing healthcare costs as elderly, low income, and disabled patients sometimes depend on government-funded transportation in the form of vouchers, where repeated trips result in not only wasted gas but the wasted hours of drivers repeating the same route. Another example is the high cost of daycare for parents who may have to hire someone to watch their children. If they can’t complete their exam the first time, then their childcare cost can potentially double.
Moreover, patients may take time off from work in order to get their MRI exam and may sustain financial losses as it is estimated that less than half of all workers receive paid sick leave47. When they cannot complete their exam, the time they took off is essentially wasted and additional income loss may result as they eventually have to return for another appointment that may or may not be covered by their sick leave allowance. Lastly, canceled MRI exams can sustain a financial loss due to delayed medical care resulting in the progression of an injury or illness, which in turn increases medical expenses and additional time off from work23,47.
As a technologist, you may be wondering how or why you need to know, or even care about the financial impact of MRI anxiety. The short answer is because canceled MRI exams due to anxiety can hit you where it hurts… your paycheck. Every time a patient prematurely ends an MRI exam, operational costs increase. Just like MRI physics, when you adjust one parameter, it ultimately affects others that may or may not be visually evident. This same concept can be applied to MRI anxiety and your paycheck. Throughout my career, I’ve come across technologists who don’t put much effort into helping anxious patients because they are going to get paid regardless whether the patient completes their exam. While that is true for that day, it may affect your paycheck in the future as operational costs increase every time an MRI exam is prematurely terminated or canceled. It is my hope that knowing the enormous financial impact that prematurely terminated and canceled exams have on everyone may encourage technologists to exert more effort into helping patients complete their exams using every tool or intervention they know.