What you need to know about the forces reshaping our industry.

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Are your imaging services impacted by site-of-care shifts? Here's how to find out.

By Allison ChoeNicholas Hula

November 11, 2022

    Site-of-care shifts are abundant in health care, but while many stakeholders anticipated that imaging services would be no exception and move away from the hospital, this shift has been uneven across the United States.

    Read on to understand why imaging site-of-care shifts are (or aren't) happening in certain geographies and use our checklist to anticipate if imaging market share in any given region may shift toward ambulatory sites.

    Interested in seeing which regions are experiencing imaging site-of-care shifts? Check out our National Imaging Site-of-Care Shift Map.

    Overview of imaging site-of-care shifts to date

    The imaging industry has seen pressure to shift services away from hospitals and towards lower-cost, freestanding sites. Three forces have played an outsized role in driving this trend:

    • Policy and regulation: Relaxing certificate of need (CON) laws, site neutral payment policy, and ACOs or other value-based payment programs all may permit or incentivize imaging site-of-care shifts.
    • Purchaser preference: Health plans and some employers are steering patients towards lower-cost, non-hospital sites to reduce health care spending. In addition, economic uncertainty pushes consumers to become more cost-conscious, increasing the appeal of lower-cost, more convenient sites.
    • Provider competition: Established providers and new market entrants are investing in freestanding sites to expand their geographic footprint and retain or gain imaging market share amid increasing competition.

    But imaging market share by site has remained relatively stable at a national level. In fact, between 2014 and 2021 hospital outpatient imaging market share grew by 2%. The reason is that despite the presence of the forces above that should drive care out of the hospital, there are insulating factors that prevent imaging from following this trend.

    One example of a strong insulating factor is a lack of consumer action. This is partially because price transparency tools that aim to help consumers identify low-cost imaging sites suffer from low use. Some studies show that only 2% of imaging patients use price transparency tools. In addition, patients often follow their physician's recommendation on where to get their scan, or in some markets, there aren't convenient, low cost, freestanding sites available.

    But while the imaging industry has not seen broad site-of-care shifts at a national scale, local market variables have overcome insulating factors. This results in imaging services shifting away from hospitals on a regional scale.

    Local market dynamics triggering imaging site-of-care shifts

    The local market variables that dictate regional site-of-care shifts fall into four categories: provider competition, payer activity, patient consumerism, and general market characteristics. Use the below checklist to determine the likelihood of future shifts in any market.

    If you answer "yes" to many of these questions, the market is likely to shift soon if it hasn't already. If not, a shift is unlikely, but you should continue to monitor the market for signs of change.

    Provider Competition: Consider what medical group or hospital competition exists in this market and what they're doing to retain or gain market share.

    • Does this market have a high number of independent physicians? If so, are these physicians expanding outpatient access?
    • Are competitors in the region using off-campus sites and screenings to attract new patients into their system?

    Payer Activity: Take note of if payers or employers in the market have announced new policies to influence where care occurs. 

    • Have any payers in this market expressed interest in reducing health care costs by implementing site-of-care restrictions? (Even if these restrictions are for other services, this may signal interest in doing the same for imaging).
    • Is this region active in the transition to capitated payment or risk-based contracts?

    Patient Consumerism: Determine if this population is price sensitive.

    • Are patients in this region taking on more responsibility for cost and asking about lower-cost sites of care?
    • Are patients in this population prioritizing cost and accessibility over other factors such as quality?

    Market Characteristics: Consider the diversity of this market and regional regulations.

    • Does this market have high commercial payer mix?
    • Does this state lack regulations such as CON laws that inhibit freestanding shifts?

    Regional imaging site-of-care shift maps


    Interested in seeing which regions are (and aren't) experiencing imaging site-of-care shifts?

    Check out our Regional Imaging Site-of-Care Shift Map to find out

    See the map


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