Radiology costs, fairly stable since 2005, are rising again for insurers, according to HealthLeaders-InterStudy.
In several recent reports in Health Plan Analysis, HealthLeaders-InterStudy analysts found that insurers are using traditional approaches like pre-certification to control costs, but they're also using multi-pronged strategies to educate providers about proper test use.
"Industry observers estimate that radiology costs have risen more rapidly than other healthcare expenses," said Jane DuBose, director of health plan analysis for HealthLeaders-InterStudy. "Contributing to this growth is the emergence of new technology, such as breast-specific gamma imaging and more widespread use of imaging technology in general."
UnitedHealthcare has initiated an imaging accreditation program for providers in 38 states. When a physician orders a test outside the guidelines issued by the American College of Radiology, a "peer to peer" dialogue occurs between UnitedHealthcare staff and the ordering physician.
According to UnitedHealthcare officials, 3 percent of the interventions have led to changed tests, while 9 percent have resulted in cancelled tests.
"Previously, spending was centered around hospitals, but now there are more independent testing facilities and physician offices have increased access to equipment, so health plans are actively engaging in cost containment strategies to help manage the increased cost of more widespread use," DuBose said.
In Nevada, Anthem Blue Cross and Blue Shield is using data to give providers more information about best practices on imaging techniques in hopes of lowering imaging costs, which account for 10 percent to 12 percent of its entire medical costs in the state.
"Plans throughout the country are struggling with how best to control imaging costs. Florida, for instance, as the home to 3.15 million seniors, is a hotbed for imaging, and leads the nation in radiology spending per Medicare patient," said DuBose. "As use of imaging technology grows, health plans will likely explore more programs to ensure providers are up-to-speed on the latest guidelines."
How is your practice handling this issue? Send your comments to Associate Editor Chelsey Ledue at chelsey.ledue@medtechpublishing.com.