Ayla Ellison | June 5, 2018
A new imaging policy rolled out by Anthem Blue Cross Blue Shield in 13 states will likely cut into hospitals’ profits, according to Bloomberg Law.
Here are four things to know:
1. Under the new policy, Anthem Blue Cross Blue Shield will only pay for outpatient MRIs and CT scans when members get them at freestanding imaging centers. The health insurer rolled out the policy in nine states in 2017 and four more states this year, according to the report.
2. There are several exceptions to the new policy, which is aimed at pushing patients to receive MRIs and CT scans at less costly outpatient centers. For example, the policy doesn’t apply to patients under 10 years old or when imaging is preoperative and the surgery is occurring in the hospital. Rural areas that don’t have freestanding imaging centers are exempt from the new policy.
3. Since imaging services are among the most profitable services hospitals perform, the new policy is likely to hit hospitals’ bottom lines. “It’s hard to give a sense of the magnitude, but I do think it’s going to be material,” Christopher Stanley, MD, director of the healthcare practice at Navigant, told Bloomberg Law regarding the potential financial effect on hospitals.
4. Dr. Stanley said hospital margins will be directly affected when hospitals provide outpatient imaging services and Anthem denies the claims. He said the new policy could also have an indirect effect on hospital margins if physicians divert patients to freestanding imaging centers when the patient meets an exception to Anthem’s new policy. He also noted patients who receive imaging services at a freestanding center are less like to go back to a hospital if they need additional testing, even if the services are covered.
Source: Beckers