MRIs Why So Expensive?

[JohnnyVegas]

I haven't started rotating through the hospitals so I am not aware of all the dynamics at play but it seems like this technology would be helpful in routine scans and checkups and so forth. Normally, the cost of technology decreases rapidly after its introduction. I know the staff still has to be paid but it seems like that doing alot of patients would make it cheaper. Why can't MRI centers be opened up where people go to get routine checkups as part of their physical exam in primary care?

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[BassDominator]

The problem with routine CT/MRI scans is you can find a lot of incidental things that can be more trouble than they are worth.

For example:
1) unexplainable findings get a million dollar workup and turn out to be nothing or we have no clue what they are.
2) prostate cancer found in an elderly man, who will die from a heart attack long before the cancer could ever kill him
3) an aggreassive cancer is found early, but without effective treatment, you only increase the lead time bias and the length of time the patient has to live with the diagnosis
4) unecessary patient anxiety and routine scans diverting valuable resources from people who need it most.

I'm sure the argument would be different if the scans were cheap, easy to read, and access was a non-issue; but as it stands, they generally make very poor screening tools for asymptomatic patients.

 

[NinerNiner999]

I agree with the incidental findings response, as many do appear when reading MRIs. However, I too am unclear as to why they are so expensive to obtain. I would guess the machines themselves are around $300-500k. I also assume the radiologist charges a reading fee of around $150, and that the tech staff that actually do the work and scanning account for a portion of the charge as well.

Using rough (and probably inaccurate) estimates, and assuming the standard charge for an MRI scan is around $1400. Taking away the radiologist fee and tech fees, that would leave around $1000 just for using the machine. By my math, that would mean the machine would be paid for after 300-500 patients (which can easily be accomplished in a year). I suppose one would also have to factor in maintenance and power bills.

Perhaps the cost is so high to deter its use, or to serve as a reserve cash cow for the hospital budget. There are probably better reasons for its cost that I can't think of right now...

 

[Docxter]

An uptodate MRI scanner costs about $1,000,000 and you also have the costs of building the room, special electric power supplies, magnetic shielding of the walls, ceiling, and roof if needed,. The newer higher-field, higher end magnets cost about 2 to 3 million. And the magnets need to be replaced or upgraded every few years since they become old and outdated. High field MRI machines have an enormous maintenance cost. They have a liquid nitrogen core surrounding a liquid helium core which need to be cooled in order to maintain superconductivity. They are always "on" since if you turn them off, the liquid gases will evaporate. The electric bills are very high. If the gases evaporate, it takes a couple tens of thousands of dollars to fill it back up. Other associated fees include film costs, film laser printers, networking, and in the case of PACS, the PACS workstations which are quite expensive with their multithousand dollar graphics cards and monitors, upgrades, archive and backup archive costs and the maintenance contracts. Also, the department pays a couple tens of thousands of dollars to the vendors for periodic maintenance and software upgrades. We had a problem with our PACS system one night and when the service technician came to fix it at 2AM, I had to sign for it and I saw that they charge the department about $2000 dollars per hour!!!

Each exam fee has a professional fee component and a technical fee component associated with it. The professional fee (interpretation) is about 1/5th to 1/10th of the technical fee depending on the exam and is usually collected by the radiology department. The technical fee is collected by the entity owning the machine (often the hospital). This fee is what often the hospital uses to covers money losing operations in the hospital (indigent, uninsured, and underinsured inpatients, ER personnel and physician salaries if an inner city ER with an indigent population, etc.)

As far as using MRIs for routine screening, well, they have to be cost effective and show improved survival and morbidity at a cost affordable to society. That hasn't happened yet. Maybe some 10-20 years down the road they will be, I don't know.