Whitney Palmer

Patient Steerage Could Harm Radiologists, Confuse Patients

Published on the April 18, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

As implementation of the Affordable Care Act continues, all sectors of the healthcare industry are being called upon to increasingly rein in costs. For many insurance providers, patient steerage has proven to be an effective strategy. But the impact on radiology has been largely negative, industry experts said.

Patient steerage in radiology occurs when outside forces — usually insurance providers — actively direct patients or physicians to lower-cost radiology practices. And, this strategy is becoming more prevalent nationwide, said Geraldine McGinty, MD, chair of the American College of Radiology’s (ACR) Commission on Economics.

“Our feeling is that as radiology benefit managers have maxed out on the initial imaging volume savings they can offer to clients, so they’ve started participating in programs to drive patients to facilities where the payers have negotiated lower reimbursement rates,” she said. “Recently, it’s been more aggressive due to increasing involvement of patients as they take on more responsibility for their care through higher-deductible plans.”

In fact, according to an informal survey by the Radiology Business Management Association (RBMA) in September 2012, 65 percent of respondents reported experiencing active patient steerage from either radiology business management (RBM) groups, payers, or both. With active steerage, payers give patients incentives, such as gift cards, for choosing lower-cost providers. In addition, 47 percent confirmed the presence of passive steerage — simply making cost differential data available to patients and providers.

However, patients are also driving a certain level of steerage. A recently-published joint ACR-RBMA paper credits high-deductible insurance plans and patient cost awareness with some patient redirection.

What Payers Are Doing

While not all payers have patient steerage programs, many do. For example, in September 2011, Anthem Blue Cross Blue Shield in Ohio implemented a steerage program for imaging services through which company representatives called patients in attempts to redirect them toward lower-cost providers. Within nine months, more than 3,500 patients had been called and steered to different imagers.

In addition, WellPoint launched a passive steerage campaign with OptiNet, an Internet portal through which referring physician were encouraged to schedule patients with lower-cost imagers. When referrers largely ignored this resource, however, WellPoint enlisted RBM company American Imaging Management (AIM) to call patients directly. According to AIM marketing director Ana Perez, nearly 20 percent of patients chose lower-cost imagers in response to the phone calls.

Other payers, such as UnitedHealthcare, also provide radiologist cost information, but they do not actively contact patients. Still other payers successfully steer patients by classifying certain providers as out-of-network in a patient’s insurance plan.

The Impact of Patient Steerage

The increasingly prevalence of patient steerage can potentially impact practices and departments on a variety of levels, McGinty said. According to the ACR-RBMA paper, she said, radiologists should be aware of the three main ways patient steerage can affect everyday practice.

1. Daily operations: When payers redirect patients, providers can lose any time they’ve already spent in the pre-authorization process. They can also experience productivity dips , and if they don’t know patients have been steered elsewhere, they  could face vacant or missed appointment slots. Imagers could  also be asked to answer patient and provider questions about any steerage and why it occurred. Overall, up to 82 percent of RBMA survey respondents indicated steerage decreased their patient volume. However, some respondents — about 14 percent — actually saw volume increases due to patient steerage.

“The big item will be the loss of business, and virtually every practice is looking at a decrease in volumes,” said David Levin, MD, a radiologist with the Center for Research on Utilization of Imaging Services at Thomas Jefferson University. “It’s not like in the early 2000s when volumes were growing like crazy and it wasn’t a problem if we lost a little business because insurance steered our patients elsewhere. No one feels that way anymore.”

2. Legal issues: When payers actively steer patients to lower-cost imaging centers and away from a referring physician’s initial suggestion, they open themselves up to potential medical liability if findings, such as a lung cancer, are missed. In addition, legal action can also be launched against the chosen imager, the imager’s corporation, and the RBM. It’s also possible, especially with active steerage, that these activities violate the federal anti-kickback law that forbids any payments or solicitations that influence patient health decisions.

According to the ACR-RBMA paper, radiologists could also assert payer-directed steerage impedes their legal right to practice, defames their professional reputations by listing them as lower-tiered providers, or violates any existing contracts they have with facilities to receive a certain amount of referrals.

3. Provider relationships: Any payer-directed steerage can disturb existing healthcare relationships, McGinty said. Referring physicians often have a small cadre of imaging providers, chosen for their levels of quality and service, to whom they send patients. Redirecting patients to different imagers can damage long-term provider partnerships and can impose on referrers the additional cost of transferring all patient records to a new imager. Any instances of incomplete reads prompt the need for a second radiological opinion. And, the radiologists providing the second read do not receive reimbursement.

Impact on Patients

While survey data exists to support the negative effect steerage has on providers, the verdict is out on how much payer redirection influences patient care.

The ACR’s biggest concern, McGinty said, is that steerage can confuse patients.

“Patients build relationships with their physicians over time, and they value their doctor’s advice and guidance,” she said. “We don’t want to see those relationships disrupted or see patients’ confidence shaken when it’s suggested they see an imager their doctor didn’t recommend.”

It’s also paramount, she said, to make it clear to patients that payer recommendations are only cost-based suggestions. Many patients are unaware they have a choice to simply pay a higher fee for seeing the imaging provider chosen by their referring physician.

Payer steerage also increases the risk that patients will be sent to a facility without ACR accreditation. But that risk is small, Levin said, adding that ACR accreditation ensures a certain level of service quality.

“I don’t think steerage will impact patient care that much. People will get scans if they need them even if insurance companies steer patients to places they think are more affordable,” he said. “It’s not as if there’s a huge variation in quality so that if you go to my hospital you’ll get a great scan, but if you go to the hospital down the street, you’ll get a lousy one.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/patient-steerage-could-harm-radiologists-confuse-patients

April 25, 2013 Posted by wjpalmer | Healthcare | active patient steerage radiology, American College of Radiology Commission on Economics, American Imaging Management, Anthem Blue Cross Blue Shield, Carolina Regional Radiology, Center for Research on Utilization of Imaging Services Thomas Jefferson University, David Levin, effect of patient steerage of physician relationships, Geraldine McGinty, Imaging 3.0, impact of patient steerage, OptiNet, passive patient steerage radiology, patient steerage, patient steerage and federal anti-kickback law, patient steerage and transparency with patients, patient steerage radiology, Radiology Business Management Association, Sheryl Jordan, UnitedHealthcare, WellPoint | Leave a comment