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Insurer Pushes Patients Toward Cheaper Scans

February 1, 2011
Written by: , Filed in: Diagnostic Imaging, Medical Ethics, Practice Management
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In a pilot program, Anthem Blue Cross and Blue Shield of Indiana is trying to persuade some policyholders who have been approved for advanced imaging to switch to an imaging facility that’s cheaper.

Anthem says it’s just trying to steer its patients toward high-quality facilities that charge less. Radiologists say emphasis is being placed on cost above quality of patient care.  Some referring physicians say the insurer is interfering with the doctor-patient relationship.

“I would never say it’s not important to look for ways to provide cost-effective care,” said Bibb Allen, MD, chair of the American College of Radiology’s Commission on Economics, “but I think consideration about where patients are sent goes beyond the cost, and I’m not positive this particular program takes into consideration those things, because it’s making the patient, who may not know all those things, the arbiter.”

Dr. Allen was quoted in a story by Shari Rudavsky in the Indianapolis Star on Monday.

The program, which began in December, affects only policyholders in Central Indiana. During the first month, Anthem says, it called about 1,400 of the 4,500 policyholders scheduled for MRI or CT scans to ask them to have their scans at different facilities. About 180 agreed.

Said Susan Pisano, a spokeswoman for the trade group America’s Health Insurance Plans:

This puts a lot more control in the hands of the individual consumer and allows the consumer to make a decision that is a good one. I think you’re going to see this kind of program more and more in the short term.

Anthem says it scores imaging sites according to criteria developed by the American College of Radiology. David Lee, Anthem’s vice president of provider contracting and engagement, says policyholders are directed to imaging facilities that score at least as high in quality as the ones to which their physicians originally referred them.

Referring physicians say that neither the patient nor Anthem may realize that the doctor has chosen a specific imaging facility for a reason. The facility’s doctors may have specialized expertise or better equipment. Or they may be in the same network as the referring physician so everyone can share electronic medical records.

The Indianapolis Star story quotes one woman who felt Anthem pressured her to change imaging facilities. She reluctantly agreed. She said that she saved little money. When she told her doctor afterward, he said the substitute imaging facility could not provide the scan resolution her doctor wanted.

Linda Wilgus, executive director of the Northwest Radiology Network in Indianapolis, said it’s that kind of difference between facilities that Anthem’s scoring system can’t pick up:

There’s more than radiology services being a commodity. It’s more than just going and getting your tires changed. This is a physician-to-physician relationship.

Wilgus said Northwest has lost some patients and gained others under the Anthem program.

Related seminar: Diagnostic Imaging Review: For Residents, Fellows and Radiologists

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One Response to “Insurer Pushes Patients Toward Cheaper Scans”

  1. Radiology Daily»AlertArchive » Insurers Pay Patients To Opt For Cheaper Tests on March 27th, 2012 at 10:06 am

    […] mentioned a couple of instances, last year and earlier this year, of insurers trying to persuade patients who had been referred for advanced […]