Whitney Palmer

Healthcare. Politics. Family.

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 | Healthcare | , , , , , , , , , , , , , , , , , , , , | Leave a comment

Radiology Leadership: Proposed Reimbursement Cuts “Arbitrary”

Published on the July 12, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

A new round of potential cuts to radiology reimbursement has many in the industry expressing anger and frustration. Radiology leaders have called the proposals “arbitrary” and “unfounded,” and all agree the reductions will negatively impact practice management and patient care.

CMS this week released its proposed Medicare Physician Fee Schedule for 2013, calling for a 4 percent to 19 percent drop in radiology reimbursement rates. The proposal would also extend a contentious policy that governs imaging conducted by a single physician during one patient encounter.

“The most important thing to remember is these are the latest in a series of arbitrary cuts to radiology reimbursement that started with provisions back in 2006,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Commission on Economics and the ACR Board of Chancellors. “We’ve long argued that CMS has flawed data, and they continue to single out radiology based on the perception that imaging is a growing market with run-away costs. That’s simply not the case. Imaging and the associated spending levels are back to early 2000s levels.”

According to the proposed rule, many radiology services would see reimbursement levels drop: 19 percent in radiation therapy centers, 15 percent in radiation oncology, 8 percent in diagnostic testing facilities, and 4 percent in nuclear medicine. These cuts would be reallocated as 7 percent reimbursement increases to family medicine physicians and other primary care providers.

The quality of patient care, particularly in outpatient radiation therapy centers, could decrease if these proposed reimbursement cuts take effect as-is, McGinty said. Many of these centers would likely close their doors, limiting patient access to this type of high-quality, cost-effective care.

The industry’s strongest outcry, however, stems from a measure to expand the current 25 percent multiple procedure payment reduction (MPPR) on provider services for CT, MRI, and ultrasound. Currently, the MPPR applies to imaging services rendered by the same physician to the same patient during the same encounter. The new proposal would extend the MPPR to other physicians within the same group practice who performed subsequent procedures in those same patient encounters.

If this proposal becomes permanent, it will have a chilling effect of how providers work together, said Paul Ellenbogen, MD, FACR, chair of the ACR Board of Chancellors.“These cuts discourage doctors from working as a team and pull the rug out from under the very physicians working to save these people’s lives,” he said in a written statement.

There’s also a chance expanding the MPPR will have a significant, negative impact on work flow, said Mike Mabry, executive director of the Radiology Business Management Association. It’s unclear whether smaller or more rural radiology practices would be able to effectively and efficiently change their billing strategies.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/news/display/article/113619/2090032

July 13, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , | Leave a comment

Radiology Job Market: 6 Steps To Greater Employment Success

Published on the July 5, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

It’s no mystery that today’s radiology job market is tight. Many recent graduates chose radiology before the economic collapse when jobs were plentiful, and now they’re struggling to get their foot in the door either in a hospital or a private practice. And, they’re not alone. Older job seekers are also struggling as practices are forced to downsize in an effort to cope with dwindling reimbursement. A recent informal Diagnostic Imaging poll found that only a quarter of groups are hiring, and 53 percent are still thinning the ranks.

At this point, it’s unclear how – or if – Thursday’s U.S. Supreme Court decision on the Affordable Care Act will impact the industry and its job pool, but there are a few tactics job seekers can use now to improve their chances of securing employment.

1. Create a detailed narrative for yourself. It isn’t enough to simply reply to a job posting with your CV and contact information, said Patrick Moore, president of Smart Physician Recruiting. Employers receive at least 20 to 30 applications per job, so you must tell your story to stand out from the crowd.

“Cover letters are a must when applying for a new position,” Moore said. “Tell your story about who you are, what your training was like, and why you are unique. Otherwise, you’re not likely to receive a phone call.”

2. Be willing to work outside your subspecialty. Many practices hire radiologists because of their training in a particular area. But in a growing number of cases, radiologists are being called upon to work outside their wheelhouse, said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Commission on Economics and the ACR Board of Chancellors.

“Indeed, there are some practices looking for someone to work entirely within their subspecialty,” McGinty said. “But, there are many who need someone flexible – someone who will do something other than what they learned during fellowship. Job seekers must have a willingness to pitch in.”

3. Pick your desired location wisely: If you’re applying for a job in a different geographic location, have and share the specific reasons why you chose it. It isn’t uncommon in this tight job market to see graduates from New England schools applying for jobs in the Southwest without any clear ties to that region, Moore said, and it’s easy for employers to spot someone who is applying wildly in the hopes of finding a job.

“If you do want to choose a different geographic region, seek out practices in that area while you’re in residency or during fellowship,” Moore said. “Make phone calls. Connect with them at conferences. Explain your reasons for wanting to come to their region because they’re looking to find people who will be long-term hires.”

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2088125

July 5, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , | Leave a comment


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