New Anthem Imaging Coverage Policy Will Harm Patient Access to Imaging Care
RESTON, VA — The new Anthem cost-cutting policy of not covering computed tomography (CT) and magnetic resonance imaging (MRI) performed in hospital outpatient departments is arbitrary and unwise.
Economically motivated steerage of patients compromises the physician-patient relationship and undercuts integrated health care efforts. It also sets up another nontransparent preauthorization process that moves medicine backward.
The American College of Radiology (ACR), other large medical societies, Congress and Medicare have put in place a system where providers consult electronic appropriate use criteria when ordering imaging exams. This ensures that the exam is appropriate according to latest medical guidelines.
Federal law requires use of these clinical decision support (CDS) systems when ordering advanced imaging for Medicare patients starting as early as January 1, 2019. Under the Anthem plan, cost alone determines care with little consideration for quality. Physician referral patterns are commonly driven by that physician’s experience with the quality of imaging care provided at a given facility.
Denying patients covered access to care at such a vast number of facilities will delay care, increase wait times and force many patients to travel outside of their communities to get advanced imaging.
The policy may particularly impact patients in inner city and rural areas. In many areas, the local hospital outpatient setting may be the only immediate access point for advanced imaging outside of the main hospital.
The ACR is concerned that Anthem's policy will force patients to locate an ever-declining number of freestanding imaging centers and/or physician’s offices to access imaging services.
If patients do find local, freestanding imaging centers, such facilities may not be immediately prepared to care for an influx of patients now denied covered access to hospital outpatient imaging. Also, by steering all patients out of the hospital, odds of these facilities caring for a patient that may experience complications is increased.
Forcing all advanced imaging out of hospital outpatient departments may prompt many of these facilities to cut back on standard imaging (X-ray, etc.) or close altogether. This may be particularly true in areas where hospitals care for many indigent patients.
While the new Anthem policy may save the company money in the short term, patients will pay the price through decreased access, longer wait times and longer commutes to receive care. Health care reform will also be slowed or even rolled back.
We urge Anthem to reconsider their approach and work with providers and hospitals to achieve better coverage policy.
About the American College of Radiology
The American College of Radiology (ACR), founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care.
To arrange an interview with an ACR member, please contact Shawn Farley at 703-648-8936, Maryann Verrillo at 703-390-9822 or email PR@acr.org.