What Matters in Quality in Imaging
By Julia Kroll
A century of healthcare
Imagine getting sick a century ago. Your entire town only has a few doctors, or maybe just one. You don’t know other doctors in any nearby towns, and even if you knew their names, you would have no idea whether they were better than the one who treated your cousin’s diphtheria and your little sister’s measles. You go to the one doctor you know, and cross your fingers that they’ll give you the right diagnosis and treatment. This system doesn’t offer you any choice, and you don’t have a good understanding of the value of your doctor’s care.
We’ve made countless world-changing technological developments over the past hundred years, but it’s still incredibly difficult for patients to identify which doctors they can go to, and to know whether a doctor is giving them high-value care. Luckily, we now have cars to drive long distances to out-of-town facilities, phones and email for instant communication, and the internet to research the huge variety of options available to patients—not to mention the healthcare technology itself. But with all those resources, you still need to know which characteristics add value to your care.
Cost ≠ quality
(Photo credit: Ben Earwicker)
In areas besides healthcare, comparison shopping relies on the idea that a more expensive product offers extra benefits or higher quality, so when you find pricing information for a few MRI providers, you may be assume that the least expensive option is also the lowest quality — but healthcare is unusual because study after study has shown quality and cost of care are not related. Expensive MRI providers aren’t necessarily high quality, and inexpensive providers certainly aren’t all low quality. While this makes choosing a provider trickier since you can’t judge quality by a price tag, it actually benefits you, because all things being equal, you can choose the most affordable care without worrying that you’re sacrificing quality for cost. You can’t measure quality with cost, but you can learn about a few other aspects that affect the value of care a provider offers.
So what does matter?
You can measure quality of care by speed and ease of scheduling an appointment, type of equipment used, imaging protocols, subspecialty and expertise of the reading radiologist, how the results are shared, and billing practices.
Scheduling an appointment
One basic indicator of quality is how soon you can make an appointment. Once your doctor has recommended that you get an MRI, you want to do the scan as soon as possible to protect your health. You’ll receive better care if you schedule an appointment in the near future, rather than being forced to wait weeks or months. You have many options of MRI providers, and if one provider expects you to wait a long time for your procedure, they’re not giving you timely, high quality care. Once your doctor has sent your order to a facility, you should expect the facility to call you within two days to set up an appointment for the following week.
Ask about the MRI equipment a provider uses. Machines with a 1.5 Tesla magnet are standard of care, so ask the provider about magnet strength, and make sure the provider uses machines with at least a 1.5 Tesla magnet. But also keep in mind that stronger isn’t always better, so you can talk with your doctor about the best magnet strength for your personal circumstances.
Every facility and radiologist decides its own imaging protocols, which are a set of rules that determine the different thicknesses and angles where the images are taken. Protocols are important because images taken during an MRI that follows a poor protocol may not capture the cause of your health problems. For instance, images taken at thicknesses that are too widely spaced may miss an entire tumor, and images that only cover some of the vertebrae may ignore the problem areas of a spine. Each facility will have a different protocol for each area of the body.
A technician will operate the MRI to take the images, but the radiologist is the doctor who interprets the images and makes a diagnosis. Even if the MRI images capture your problem, you still need a skilled radiologist to understand the story the images tell. Many radiologists have a subspecialty, or an area of the body that they are especially experienced in examining. You will get the best diagnosis from your MRI if you go to a radiologist whose subspecialty matches your problem area. In addition to subspecialty, it’s important how many years of experience the radiologist has in their subspecialty, and how many cases they handle daily. As with any skill, radiologists who have had more extensive training and experience in their subspecialty will be more likely to recognize all of the clues in the images and make an accurate diagnosis.
Sharing the results
Once the MRI is complete and the facility has your images, they will need to send the results to your referring physician. Since these are complex digital images, sharing results is more complicated than it may seem. Ideally, the MRI provider will send the results electronically, with the imaging files in a usable format, but they should at least fax the results to your doctor in a timely manner and give you a CD with the image results. In some cases, especially for surgery, your doctor may request the actual films, and in those cases it’s important to confirm those films will be sent.
You’ll want to make sure that the provider has fair, convenient billing practices. Before you do the MRI, a good provider will offer you an accurate estimate of the out-of-pocket cost and network designation. Always ask and confirm that the radiologist who will read your scan is in-network, and that all components will be billed together. You can also ask ahead of time to see their billing site, and confirm that they will accept an online health savings account, credit card, or another method that is convenient for you. You’ll also want to know if they have a working phone number that connects to a human being who can answer your questions about billing. You’ll be surprised how many facilities still make you pay by check and snail mail, and don’t have have any agents available to respond to billing questions.
After the scan, you should expect a clear, itemized bill, noting in-network and out-of-network charges, patient responsibility, and amounts paid by insurance. If a facility claimed to be in-network prior to service, they should not have any hidden fees, such as radiologists who are out-of-network, that create large extra charges.
We can help
This is a lot of information to consider, but we’re more fortunate than previous generations that we’re able to access it at all. Even so, it’s not easy, and you don’t have to figure everything out on your own. Tools like Stroll can provide you with details about many different providers, making it easier for you to understand your options and decide on the best one. Now that you know what makes for a good MRI, you can also find out what to expect from an MRI. If you haven’t seen your doctor yet, mention this article at your next visit. We think they’ll be impressed. If your doctor has already ordered an MRI for you and you’re ready to select a provider, you can go ahead and use our patient tool. Happy strolling!