Average prices for MRI and CT scans ranged from 70 percent to 149 percent higher at hospitals, according to an analysis published by the Healthcare Financial Management Association, a membership group for health care finance professionals.īut price isn't the only important variable, and the perception that all imaging studies conducted by qualified providers generally yield comparable results is wrong, Binder says. Hospital imaging is indeed pricier than imaging at freestanding centers. "Members can save close to $1,000 out-of-pocket for some imaging services for those who haven't met their deductible, and up to $200 for those whose plans require only a copay." "There are huge cost disparities for imaging services, depending on where members receive their diagnostic tests," she says. The new policy could save Anthem enrollees hundreds of dollars, says Lori McLaughlin, Anthem's communications director. In rural areas that lack at least two imaging centers that aren't owned by hospitals, outpatient scans from hospitals will still be approved. The policy doesn't apply to mammograms or X-rays. Doctors who request nonemergency outpatient MRI or CT scans that can be done at an independent imaging center rather than one owned by the hospital will be given a list of centers eligible for patient referrals. Under the new policy, AIM Specialty Health, an Anthem subsidiary, will also evaluate where they should be performed. Imaging tests are generally subject to preapproval by Anthem to confirm that they're medically necessary. "Anthem would be better off judging the quality of these diagnoses," regardless of where they're provided, and setting payment accordingly, she says. "To achieve true value, you have to have high-quality care at a good price," says Leah Binder, president and CEO of the Leapfrog Group, a nonprofit organization that advocates for improved safety and quality at hospitals. The insurer began phasing in these changes in July and expects to finish by March.Īnthem says the change is aimed at providing high-quality, safe care while reducing medical costs.īut critics say that imposing a blanket rule that gives preference to freestanding imaging centers is at odds with promoting quality and will lead to fragmented care for patients. Tightening the screws on pricey imaging exams, health insurer Anthem will no longer allow many patients to get MRI or CT scans at hospital-owned outpatient facilities, requiring them to use independent imaging centers instead. Critics of Anthem's policy say imposing a blanket rule that gives preference to freestanding imaging centers is at odds with promoting quality and will lead to fragmented care for patients.
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