Modern diagnostic imaging techniques, such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scanning, has led to the earlier diagnosis and treatment of a variety of diseases and injuries. However, there is concern that the extensive use of such technology may not be cost-effective. Rather than address the economics of health care, we will examine how the total charges for diagnostic exams are structured.
Diagnostic imaging facilities can be grouped into two general classes. The first of these is the “full service” or “comprehensive” imaging center. Such centers, whether hospital-based or located in a free-standing facility, offer other diagnostic imaging services as well as CT and/or MRI exams. These facilities are always subject to extensive federal and state regulation and all are approved to receive Medicare, state medical assistance, and private insurance carrier payments.
The second type of facility typically offers substantially-discounted, cash-only, rates for special types of examinations such as screening examinations for heart disease or colon cancer (“virtual colonoscopy”). While the vast majority of such imaging facilities offer excellent services, it is important to remember that some centers are for-profit operations that depend on a high patient volume per unit of time in order to remain profitable. Many of the “cash discount” facilities are not approved for insurance payments.
The total charge for any diagnostic imaging study can be broken down into two sections, a technical component that covers the use of the physical equipment involved in the examination, and the professional component, which is the charge made by the physician who interprets the results of the exam from images recorded on x-ray film or digital images on a computer. In some cases, particularly in those diagnostic centers that offer “screening examinations,” such charges may be combined into a single fee.
The technical component of a diagnostic examination can be best thought of as the charge for the “use” or “rental” of the machines as well as the technologist’ salaries and any supplies used in the course of the examination. As a general rule, a MRI examination will cost more than a CT exam because MRI machines are more expensive to purchase and operate than CT scanners. Also, an exam that is done “with and without contrast” will typically cost at least 50% more than a single examination.
The professional component of either a CT or MRI examination is the charge made by the physician who personally interprets the results of the examination and provides a written report of his or her interpretation of those findings to the health care provider who referred the patient to the facility. Although there is considerable variation between geographical regions and in the type of examination being interpreted, most professional fees will range from 15% to 30% of the technical component charged. In some facilities, particularly in those offering a “cash discount” or those offering low cost screening examinations, the professional component is included in the examination fee itself.
To summarize, the question of whether to order either a CT or MRI examination is made by a health care practitioner who will take into consideration factors such as the disease process to be examined as well as the advantages of one testing modality over the other. Since there is considerable nationwide variation in the total charges for such examinations, the consumer is advised to contact a number of diagnostic imaging centers in order to obtain the most economical source of these examinations.
CRTMedical is a medical billing service based out of Detroit, Michigan.