![]() ![]() His statement said the policy could lead to care fragmentation “by requiring a patient to travel farther and visit multiple locations for treatment rather than receiving care in an integrated setting.”īut in an increasingly consumer-driven world, cost is becoming a key factor. Such prohibitions can result in patients being steered away from a hospital to an insurer-preferred freestanding facility that may lack the capability to quickly assess a patient’s condition.” Decisions by insurers to restrict where patients are permitted to receive a necessary medical procedure fail to meet that standard. Julian Walker, vice president of communications for the Virginia Hospital & Healthcare Association, said in a prepared statement the Anthem policy is overly restrictive: “Decisions about advanced imaging tests that patients need to diagnose and treat an illness or injury should be made with patient interests in mind. Hospitals have said it would undermine hospitals’ revenue stream, and ability to subsidize unprofitable services, such as trauma and emergency care. Hospitals have argued such a move would allow independent facilities to “cherry pick” lucrative services, one of which is typically imaging services. Hospitals have long argued against getting rid of what’s called certificates of public need in Virginia, which require facilities to apply for approval to open a medical facility. The Anthem policy is the latest salvo in the competition between independent facilities and large hospital systems. Also, CHKD uses pediatric radiology protocols using the lowest possible dose of radiation based on each child’s age and size. “For example, many children require sedation for MRI scans, and CHKD offers this,” the statement read. However, public spokeswoman Ridgely Ingersoll emailed a statement saying CHKD has pediatric radiologists trained to treat its unique patient base of children. Both said it would be premature to comment on the impact on the hospital systems and their patients.Ĭhesapeake Regional Healthcare issued a statement expressing concern about the loss of access to Anthem patients, “and the disruption to their continuity of care when scans are performed outside of their preferred hospital system.”Ĭhildren’s Hospital of The King’s Daughters said Anthem’s official notification is expected in December, so more information is expected then. ![]() Spokeswomen from Sentara Healthcare and Bon Secours Hampton Roads said they have posed questions regarding the policy to Anthem and are awaiting word from the company. The policy focuses on MRIs and CT scans, not X-rays or mammograms. Physicians will be given lists of free-standing facilities that provide such services when they order a test. It will be implemented in Virginia, California, Connecticut and Maine on March 1. The policy, called the Imaging Clinical Site of Care Review Program, was rolled out in Indiana, Kentucky, Missouri and Wisconsin on July 1, and in Colorado, Georgia, Nevada, New York and Ohio on Sept. ![]() “It also helps health plans keep premiums more affordable.” “The clinical guideline gives members an opportunity to save up to hundreds of dollars for each imaging test,” said a statement emailed by Golden. Reimbursements will be denied in hospital settings if there’s an alternative within 30 miles, and if no clinical reason can be given that a hospital setting is needed. ![]() Virginia Anthem spokesman Scott Golden said in an email statement the policy includes MRIs and CT scans outside of emergency situations. Starting in March, Virginians insured by Anthem must seek imaging services at free-standing facilities instead of hospital-based ones. Insurance New Anthem policy will steer patients to less expensive free-standing imaging centers
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |