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.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

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One thought on “Opposition to the Anthem Policy Is Not a One Horse Race

  1. “Care is not homogeneous across communities. Policies that steer patients based mainly on cost have the potential for adverse consequences to patients. “

    Are you saying that the ACR members with more frugal and cost effective practices aren’t capable of standard of care? Spending more carefully – no fleets of Force or ranks of Revolution – and hiring at market rates will allow the less accessible and patient focused hospital setting to compete to provide for these lives

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