Builders will tell you that you can have it good, fast, or cheap—you can’t have all three. But, as health care consumers, we should insist on having it all; high quality, fast service and low cost—or at least fair—prices.
Research data indicate more than half of Americans are actively looking for pricing information before deciding on care. More than half of the nation’s imaging providers have or are developing their own free-standing imaging centers, but are they all the same?
Dr. Cristin Dickerson (pictured), founding partner of Green Imaging, PLLC, based in Houston, Texas, saw the proverbial writing on the wall while she was president of a diagnostic clinic and a self-funded employer herself. “We were a multi-specialty group with 50 doctors,” she says. “We had 400 covered lives and we came up with an idea to hold down our costs by incentivizing our employees to use our own medical services. Employees had zero out-of-pocket expenses and their deductible didn’t apply if they used our services. They were subject to their copay and deductible if they went elsewhere. That was my introduction to free market medicine and I have never looked back.”
Subsequently, she began to recognize the need for affordable imaging across the city; “There was imaging available in-network, but at freestanding centers attached to hospitals, which meant inflated hospital-contracted prices. There were many other free-standing centers largely operating out-of-network, so, I began contracting with imaging centers in Houston, leasing their unutilized scanner time at a discount.”
Dr. Dickerson founded Green Imaging to provide affordable, high-quality medical imaging for uninsured and high deductible patients in Houston, and rapidly expanded the company to provide services throughout Texas. Today, Green Imaging includes a virtual medical imaging network across the United States, owned and operated by board-certified radiologists. “I saw very early the potential for employers to use our network to hold down costs on self-funded plans because I have successfully done the same,” she says.
Dickerson says “At first, I felt like I was hitting my head against a wall to get employers to buy in. But, at a benefit conference in 2017, I began talking to Human Resource directors and hearing about so many employees asking, If I can’t afford to use this plan, why do I even have it?—I believe that is when we hit the tipping point; the year it became unsustainable. Employees were paying up to 40 percent of their insurance premiums, and yet were functionally uninsured. Because they were paying so much of their income toward their plan, they had nothing left to pay for care.” The tide turned and she began to contract directly with employers and third-party administrators who began writing Green Imaging into many employer plans.
Since then, Green Imaging has had an exciting ride trying to keep up with demand and has added more value to the system by taking steps to take the bureaucracy out of the process as well. “We are trying to consolidate and automate like [The Kempton Group]; we have not quite gotten our contracts down to one page, but we will get there!”
As Green Imaging has become sustainable, Dickerson is even more passionate about spreading the word that there are great new non-traditional health care coverage options in emerging free market health care.
I don’t want to be the cheapest price in town. I want great imaging at a fair price—that is sustainable. If you under-price yourself and go with lower quality facilities, that’s not sustainable. ~Dr. Cristin Dickerson, Green Imaging, PLLC
How it Works
The Green Imaging model helps patients make the most informed decisions about MRIs, CTs, and other imaging procedures. Unlike many other imaging facilities, the cash-pay price they provide is the “all in” price. There are no other changes or fees. Patients pay for procedures up front, with no surprise bill after the fact.
“Working with creative TPAs enables us to further simplify the work flow by eliminating redundancies. We remove traditional claims and their expense from the process, utilize existing concierge services, when available, to help schedule, and automate the process wherever possible to get the information into the hands of our specialists and our patients. We are continuously developing best practices, making things more efficient and holding down costs.”
Green Imaging, PLLC contracts for the idle time on imaging machines in-network, and because technology has progressed, images and scans do not have to be produced and read on-site. “In Texas, our model is to read the studies ourselves, thus assuring consistency and quality.
“Nationally we have a different model to assure the same type of quality. We preferentially contract with radiologist-owned imaging centers that are like-minded, which enables us to sustain the kind of relationships we’re used to,” Dickerson says. “We know these radiologists take pride in their work and they understand quality. The benefits are many: fewer middle men involved; the centers are glad to have the business and make use of under-utilized equipment; and help sustain their own centers.”
Consultant-provided analytics on Green Imaging prices in Texas compare well to a typical self-funded health care plan. Their bundled price was about one-third of the average price in a self-funded health care plan. Dickerson says, “I know as we gain traction and expand, we will get that price down further. Our own center in Houston charges $250 for a non-contract MRI. We own that center and we have enough volume to sustain that price. I believe it makes me more credible when I go in to negotiate with a new image center because I own my own facility; I understand their pain and am certain about what I can do for them.”
Dr. Dickerson has plans for a greater national presence, despite the barriers to that growth. “There are carriers who do not want us in their states and, while we also want to support free-standing imaging centers, we are not always the lowest price option. I want to continue supporting Direct Primary Care (DPC) and the whole free market system so I am happy to advise employers with employees in a single geographic area to shop for services to make sure they are getting quality images at fair prices. We are a great solution for employers who want a single resource for a wide geographic range of quality imaging. AT the same time, we are not here to compete against independent physicians, we want to bring them business they would not otherwise have.”
Green Imaging’s goal is to continue centralizing resources for scheduling and payment. With their services, employers and TPAs have fewer contracts and separate agreements to manage, providing more economy of effort. Dickerson says an educated broker can make the biggest difference. “Brokers and nurse navigators have all the tools to educate consumers and help them make the best decisions. The more they can eliminate the hassles of health care, the more satisfied employees will be with the plan and the better than plan will serve everyone.” The best tool to drive employees to a plan like a Green Imaging “bolt on” is to incentivize the employee with zero out-of-pocket cost, a low copay, or shared savings.
She is confident that TPAs who are not using Green Imaging may be costing their clients money and headaches. “Part of what we do is contract directly with employers typically reimbursing with reference-based pricing. If you take that RBP insurance card to most of the centers we work with, they will tell you they don’t take that plan.”
Dickerson says she is pleased to note that free market health care is looking over the wall. “However, if things change too quickly, we will not have enough providers and employers, and employees will get frustrated. We need to be intentional and educate physicians and providers about self-funded plans and TPAs first. They need to understand that they are spending 30% of their revenue to collect 70% of what they are contracted to receive from traditional plans in order to understand the benefit of direct contracting and reference based pricing.
“We have been working for some time to pull together a multi-specialty network of free market providers here in Houston and we still have work ahead of us. Everyone does contracting differently, but I am at a point where I can mentor people and help bring great physicians into this direct care market.”
Dr. Dickerson has been a self-funded employer and understands the needs and challenges they face. She looks forward to working with hospitals, helping them evolve the way they are paid for care over the next decade. “Until something changes in the amount of money hospitals are paid by big insurance, they will be reluctant to adopt something new. But as fewer employees choose or maintain enrollment in traditional plans, hospitals and major medical will feel that pain and start making changes.”
She adds, “The ultimate test is what do you do with an emergency room visit; how can you make that cost-effective? I know I could go in there and negotiate the bill after the fact. As a physician I have the capability to hold my costs down. But the average employee—negotiating on the back end—cannot. They may be suffering in silence because they aren’t sure exactly what their insurance will cover in the E.R.
“As soon as TPAs contract with hospital systems successfully, reasonable rates will be part of the negotiation. For the hospital, it means a lot less bad debt; they will be fairly paid at the end of the month for their services compared to what they have to wrangle out of patients with huge patient responsibility. Simply put, it is a better model.”
For now, Green Imaging is enjoying being in this space nearly exclusively. As the first and only physician-owned direct care facility providing these services nationally, they have a great head start and are on the heels of traditional companies. Dickerson’s final word; “We consider ourselves Direct Care Radiologists; we try to be much more available to referring providers; we try to be people who practice good medicine and take the time necessary to provide excellent interpretations. We offer quality at a fair price—not the lowest price—but a fair and sustainable price.”