Direct-to-Consumer Marketing of Imaging Services May Result in More Harm Than Benefit

By Linda Carroll

November 03, 2020

(Reuters Health) - Based on the availability of Groupon vouchers, direct-to-consumer marketing of imaging services seems to be expanding, with a potential for both benefit and harm, a U.S. study suggests.

The analysis of Groupon offerings in the U.S. on one February day in 2020 found 84 companies offering vouchers for more than 100 different types of medical imaging and scanning services in 27 states, according to results published in JAMA Internal Medicine.

"The best case scenario is that this allows patients to take advantage of the free market and it might help someone with a high deductible," said study coauthor Dr. Arash Mostaghimi, an assistant professor of dermatology at the Harvard Medical School and director of the inpatient consultation service in the department of radiology at Brigham and Women's Hospital in Boston.

"But based on what was available to us and from what customers were reporting, there seems to be a high risk for patients being taken advantage of or provided care they don't need," Dr. Mostaghimi added. "Decisions may be driven by economics rather than the best interests of patients."

Some of the most telling details came from patient comments on the Groupon website, which has a special area dedicated to medical imaging services.

To take a closer look at direct-to-consumer marketing of imaging services, Dr. Mostaghimi and his colleagues Googled "Groupon medical scans" with the name of each of the 50 states. For each imaging service voucher the researchers identified, they collected several "core metrics": type of imaging, price of service, retail location, company rating and number of vouchers purchased per customer.

The researchers assessed each offer to determine whether the company had outlined potential risks, required pre-imaging consultation, offered physician or technician interpretation of the results, made unsubstantiated claims, or included disease prevention and risk estimation assertions.

For each company offering a Groupon voucher, the researchers assessed the first 100 customer reviews for comments about pre-imaging consultations, motivations for purchasing imaging services, upselling, and/or additional testing.

In total, Dr. Mostaghimi and his colleagues found 84 companies offering active Groupon vouchers in 27 states for 130 different types of medical imaging and scanning services. The largest number of vouchers offered per state were in California (10), Illinois (9), Nevada (7), and Georgia (6).

The researchers also found that at least 28,380 vouchers for imaging had been sold on or prior to the date of their analysis, with computed tomography accounting for 11,720 or 43% of purchases. The average price per imaging service ranged from $60 for a body or biofeedback scan to $687 for an MRI. Of the 84 companies, 38 made unsubstantiated claims. Only one offer mentioned the potential risks of imaging.

An analysis of 2,044 customer reviews found 90 comments suggesting that upselling of added imaging had occurred. One such comment read: "The scan was awesome, but my husband didn't like the way they try to scare you into buying a full body scan and then as if that wasn't enough they try to get you to buy these huge packages." Another read: "Don't spend your time and money. After an hour talking about what you need to take care of your health, they want to sell you a scan of the whole body for almost $5,000."

Twenty-five comments included a motivation for purchasing imaging services, with all 25 commenters saying they were self-referred.

One of the biggest risks for these patients is the possibility of incidental findings, Dr. Mostaghimi said.

The economics of healthcare is very different from other areas of the economy, said Andrew Menard, chief administrative officer-radiology at the Johns Hopkins Health System in Baltimore.

"In the economics of normal consumer goods, people can rationally make choices because they understand their own wants, needs and income," Menard said. "They can make a rational decision whether to buy a Nissan or a Mercedes because it fits their needs better."

In health care, that sort of analysis doesn't work so well, even if the consumer is a physician, Menard said. "You cannot evaluate your own risk profile and optimize choices. This needs to be expert guided."

Menard agrees that one of the biggest risks is that the imaging may turn up an incidental finding. "For example, they may see a dot on your kidney," he said. "It's probably a cyst. But it's probably going to lead to a biopsy and maybe surgery. These all expose the patient to more and more risk."

There's another issue, Menard said. It's not legal for the owner of a facility to write the prescription for the imaging, he said. "If the doctor ordering the imaging is tied to the operation, I don't understand how that is legal," Menard added.

SOURCE: JAMA Internal Medicine, online November 2, 2020.