Association between price transparency and patient decision to complete outpatient imaging

Purpose

The impact of price transparency on patients' decisions to receive the recommended care is unclear. This study aimed to assess the utilization rate of hospital price estimator tools for outpatient imaging appointments, and the association between price estimator utilization and subsequent imaging completion.

Methods

In this retrospective, cross-sectional study, adult patients with scheduled outpatient radiology examinations between August 2022 and 2023 at a single tertiary academic health system were included. Data regarding whether an out-of-pocket cost (OOPC) estimate was generated for the scheduled imaging exam, the estimate generation date, amount, generator (patient vs. staff), the date of first view by patients, appointment status (completed vs. missed appointment), and demographics were extracted. The association between price estimator use and imaging completion was assessed using generalized estimation equation multivariable regression models.

Results

A total of 470,422 imaging encounters (mean age: 55.6 ± 19.1; 57.5 % female; 56.3 % white) were included. Overall, 70,437 (15.0 %) OOPC estimates were generated (99.9 % by hospital staff and 0.1 % by patients). There was a higher number of self-pay patients among those with self-generated (55.8 %) vs. staff-generated (8.9 %) estimates (P < 0.001). The odds of imaging appointment completion were significantly higher when an OOPC estimate was generated (OR,1.91; 95 % CI, 1.87, 1.95), and significantly lower when the estimate was self-generated (OR,0.29; 95%CI, 0.17, 0.51).

Conclusion

Price-aware patients with staff-generated cost estimates were more likely to complete imaging. Self-pay patients were more likely to self-generate estimates, which was associated with lower likelihood of completing imaging.