Opposition to the Anthem Policy Is Not a One Horse Race

This post was contributed by Ezequiel Silva III, MD, FACR, chair of the American College of Radiology (ACR) Commission on Economics.

Dr. SilvaSome have questioned why the ACR would oppose the new Anthem outpatient imaging policy. This policy refuses to cover beneficiaries for MRI and CT performed in the outpatient setting — with only case-by-case exceptions.

The truth is — the ACR would oppose any policy that excludes coverage for any site of service based primarily on insurer profit. That would include any new policies that refuse to cover (or dramatically reduce payment for) imaging done in freestanding centers or independent diagnostic testing facilities.

This Anthem policy is a strong-arm tactic to impel hospitals to renegotiate existing contracts. It puts patients and providers in the middle of a payment squabble. That is inappropriate.

Care is not homogeneous across communities. Policies that steer patients based mainly on cost have the potential for adverse consequences to patients. That is why a growing number of patient groups are opposing the Anthem policy.

We are not defending variations in imaging charges depending on the site of service. This is an issue that every insurer — including Medicare — is grappling with. ACR can engage in those conversations with Medicare, but has no sway with hospitals or private insurers on imaging charges.

In the long run, such meat cleaver policies by Anthem will affect imaging providers and those they serve regardless of care setting. They are little more than efforts to make imaging a commodity to be performed by the lowest bidder. Whether you practice in an office setting, IDTF or hospital you should be concerned about what this means for your patients, your practice and your profession.

The ACR is not backing one site of service over the other. We are just doing what the ACR always does: ensuring that patients have ready-access to the highest quality care in the setting they want to receive it. That is good for everyone.

See ACR resources regarding the Anthem outpatient imaging policy.

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We Are Not Alone Against Anthem Imaging Policy

Dr Thorwarth_20140414_008

This post was contributed by American College of Radiology Chief Executive Officer William T. Thorwarth, MD, FACR.

Whether you practice in an office setting or hospital, the Anthem outpatient imaging policy will ultimately affect you. It makes imaging a commodity to be performed by the lowest bidder — even if the policy may be bad for patients. And patients (and others) are starting to take note.

Just this week, the Lung Cancer Alliance, a leading lung cancer care advocacy group, urged Anthem to drop the new policy. Other patient advocacy groups oppose the Anthem policy and will tell them so in the near future.

The American Medical Association has already asked Anthem to reconsider its new imaging policy. And communities in states affected by the Anthem move are publicly sharing their disapproval.

Others are recognizing that this Anthem effort to strong arm hospitals into renegotiating contracts is not a good thing for patients, providers or coordinated health care delivery.

If you practice in the nine states impacted by the Anthem policy to date, I urge you to review the ACR toolkit of materials to help you push back against this cost-cutting move.

ACR is working with state chapters to reach out to state legislators and insurance commissioners.

I also invite you to share your experiences of the Anthem imaging policy impacting care, and encourage your patients to do so here.

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Battling Mammography Confusion

jay-baker-300-375This post was contributed by American College of Radiology (ACR) Breast Imaging Communications Committee Chair Jay Baker, MD.

Conflicting breast cancer screening guidelines from other organizations have caused confusion in women on when to start getting mammograms and how often to get them. The ACR addresses this year round, but particularly during National Breast Cancer Awareness Month (October).

Members of the breast imaging commission recently took part in radio media tour interviews with 27 stations across the country. Collectively, our message was heard by 5 million people.

On October 20 at 1pm Eastern Time, the ACR will hold a Facebook Live event on the Mammography Saves Lives (MSL) Facebook page. Among the more than 2,700 followers of the MSL page are more than 1000 patients (or patient advocates). This is an opportunity to speak directly to those we serve.

I encourage you to direct your patients to the MSL Facebook Live event. We will dish the latest on mammography benefits and risks. We will clear up misconceptions and accurately define terms they may see in the media – like: “overdiagnosis,” “false positive,” “dense breasts” and more.

I also invite you to check out the breast imaging resources section on the ACR site and the Mammographysaveslives.org tools and resources section.

  • Patients need to know that mammography has helped reduce the breast cancer death rate by nearly 40 percent since the mid-1980s.
  • They need to know why we still advise them to start getting mammograms at age 40 and continue as long as they are in good health.
  • They need to know that Mammography Saves Lives.

Are you finding that many women are confused about when to get mammograms?

What are you doing in your practice to urge women to start screening at age 40?

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