Why don't patients adhere to imaging orders?

Seven common reasons behind patient non-compliance

Members ask the Imaging Performance Partnership:

    Why do so many patients fail to adhere with CT and MRI orders? Lack of adherence can cause frustrations for providers and create challenges in care delivery. 

Our Answer: Seven Common Reasons for Non-Adherence

  • Economic climate: Financial considerations are the most likely driver, as patients may feel they cannot afford the associated costs. In some cases, they may lack sufficient insurance coverage; in other cases, the out-of-pocket costs for insured patients are still too high. Patients are increasingly on the hook for a larger portion of costs due to rising co-pays or having a high deductible health plans.
  • Preauthorization: Patients may not follow through on orders because the exam is not approved or preauthorized by their insurance company. Notably, preauthorization is generally more of a headache for the physician than the patient. To better guard against future non-compliance, physicians should be sure to check if an exam was not approved for a patient, as they are the ones who are usually responsible for obtaining preauthorization. If the physician wants the exam done, they can usually fight to get it approved by the radiology benefits manager.
  • Faulty communication: Perhaps the order was not clear or the patient was never told: a.) what specific test to get, b.) when to get it, c.) why to get it, or d.) which location to get it in. These are areas where the referring physician’s office and imaging provider can do quite a bit to make this process easier—for example, educate and properly communicate the reason for exam, schedule the patient’s exam for them, provide them with reminders, call to reschedule if there's a cancellation or no-show, and give them directions to the imaging center or hospital. 
  • Convenience: Through conversations with members, we found a logical, if unsurprising link: patients are most likely to undergo CT when they leave the hospital with an appointment already made for them at a date and time that was convenient. The facility and its location must be convenient. Patients value outpatient centers with free parking, expanded hours and locations near referring physicians.
  • Child care problems or the inability to get time off work: Many parents have nowhere to leave their children while undergoing an imaging exam or they may not be able to leave from employment.
  • Nervousness about the procedure or its results: Some patients have general fear of the significance of the results of the test, procedure, and subsequent consultation. In other cases, patients may have anxiety about the scan itself. MRIs require patients to stay still in an enclosed space for a lengthy period. Claustrophobic patients have a particularly hard time.
  • Radiation risk for CT: As a result of recent news stories, patients are now much more aware of the risk posed by CTs and some are overly concerned to the extent that they won’t get exams done. We’ve heard anecdotally that patients have cited this fear as a reason for cancelling CT exams. To allay radiation risk concerns, physicians' offices could provide information about relative risk versus benefit of CT. 

Seeking Additional Resources?

The Imaging Performance Partnership's 2012 national meeting addresses how to improve patient collaboration and better serve consumers. The Partnernship's study on Managing Radiation Risk examines ways to educate ordering physicians, parents, and patients about the risks versus benefits of medical imaging.

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