The American College of Radiology® (ACR®) teamed with the Society of Pediatric Radiology (SPR) on an April 22 letter to Anthem urging the insurer to expand its site of care medically necessary criteria to allow children up to 19 years of age to have high-tech imaging procedures performed and monitored at sites with appropriate pediatric imaging expertise, including hospital-based imaging.
Anthem was the first national insurer to implement a policy limiting outpatient hospital-based imaging to certain circumstances in 2016. This “Site of Care: Advanced Radiologic Imaging” policy requires, with limited exceptions, high-tech imaging services be performed in freestanding imaging centers rather than hospital outpatient departments. Despite previous feedback from the ACR and SPR, the pediatric exception applies only to children up to age 10.
This policy has a profoundly negative impact on the quality and safety of pediatric care for children and adolescents undergoing advanced outpatient imaging studies. Under this Anthem policy, pediatric patients older than 10 years of age are directed away from hospital-based imaging centers that are commonly staffed with pediatric specialists. This includes specialized pediatric radiologists, who are the most experienced physicians for monitoring and interpreting these advanced imaging studies, as well as the technologists and nurses who are specially trained to interact with and perform diagnostic computed tomography scan and magnetic resonance imaging examinations for the pediatric population. The 10 years of age cut-off is artificial; many childhood diseases extend into adolescence.
Questions about this policy should be directed to Katie Keysor, ACR Senior Director of Economic Policy.