Insurer Solution Helps Guide Decisions about Imaging
The Indianapolis Star included an article noting the increasing controversy surrounding use of PET and CT scans. Concerns surround the amount of radiation exposure and the costs of the exams. The amount of radiation exposure from these kinds of advanced imaging has received attention recently across the mainstream press. The Star noted that a new computer program unveiled by WellPoint, a health payer, provides information about radiation exposure.
A new business unit of WellPoint has an education solution for both patients and clinicians. It provides information about radiation overexposure from multiple imaging modalities, including nuclear scans, as well as PET and CT. Access to the solution is available to clinicians on line. This system can also help clinicians determine the most effective use of various advanced studies. Information about this new Patient Safety effort is available on the company’s website.
American Imaging Management (AIM) was recently acquired by WellPoint. The unit’s mission is to help control both the use of imaging as well as the costs associated with such. In Indiana, where WellPoint operates, there has been significant spending growth for imaging studies compared to all medical services combined. Money spent on such is increasing at a rate of about twenty percent, compared to five to ten percent for all other combined.
But the site from AIM is already causing controversy. According to information posted on the site, CT scans should not be used as a screening test. Rather, they should be reserved for patients with a known or suspected condition. Moreover, if a clinician orders a test that does not meet the guidelines specified by AIM, the claim can be denied. Clinicians note concerns about the AIM tool and similar others because of potential impact on the relationship between patients and doctors.
The benefit of these tests, particularly combined PET/CT has been demonstrated in the oncology setting. In fact, an article was posted on HospitalBuyer yesterday describing the benefits of this modality for that patient population, particularly patients with solid malignancies. Nevertheless, some questions about use for these patients too may begin to arise secondary to cost considerations.
Nevertheless, the use of particular diagnostic tests will likely continue to be a focus area of insurers. And the tool from AIM is certainly only the beginning of cost control efforts by insurers. Whether these efforts are successful is contingent, in part, on whether healthcare providers are able to embrace payer programs. A delicate balance between roles is required for these efforts to be fruitful.
March 13, 2008 Related topics: Trends, Diagnostic, Radiology, Cost savings