Fetal MRI as a Loss Leader

Purpose: Radiology practices, like any business, seek to make a profit while living up to their mission statements. Businesses often take a loss on products or services to achieve their mission or foster relationships that make money elsewhere. Such services are termed “loss leaders” because they lead a business in its mission despite losing money. Fetal MRI represents one of these loss leading service lines.

Methods/Materials: The time and labor used to perform a fetal MRI is compared to the time and labor in a standard MRI of the abdomen without intravenous contrast at the same hospital. Time to interpret both exams is compared. Consultation time with the interpreting radiologist is considered. Special training considerations are included.

Results: One facility is studied as a model that performs 30 fetal MRI exams per month. On a standard workday, a maximum 10 fetal MRI exams can be performed compared to 20 standard MRI exams of the abdomen without contrast, owing both to the anatomical complexities and inclusion of breaks and/or repositioning required with pregnant patients. Time to interpret a fetal MRI is twice the time required to interpret a standard MRI of the abdomen without contrast. Fetal MRI necessitates evaluation of both the fetus in near entirety and maternal structures. Each fetal MRI includes an unreimbursed radiologist consultation of 20 minutes per patient resulting in an opportunity cost to the practice of $70 per scan based on the average radiologist hourly compensation. Performance and interpretation of the scan requires special training of both the MRI technologist and radiologist. Benefits to MRI stakeholders include improving relationships with obstetricians solidifying future contracts and patients, impacting pregnancy termination decisions, promoting specialized services, and encouraging future business related to potentially medically complex newborns.

Conclusions: Opportunity costs related to scanner time, interpretation, consultation, and training result in significant financial losses to both facilities and radiology practices with respect to fetal MRI. Nonetheless, practices should consider offering this service line for benefits that may not be immediately financially apparent.