The American College of Radiology is “deeply troubled” by one commercial insurer’s latest attempt to undermine the specialty’s role in the healthcare delivery process.
Florida Blue issued its imaging policy update last month, with it set to take effect on May 1. The Jacksonville-based payer is concerned about the delivery of multiple imaging exams on a single patient, during a single healthcare encounter. To address this, Florida Blue is applying reductions of 50% to the technical component of payment (covering technology, supplies, etc.) and 5% to the professional component (which goes to doc supervision and interpretation) of any second and subsequent exams.
ACR slammed the decision in a recent letter to Florida Blue President and CEO Pat Geraghty, calling it “imperative” that the payer “rescind this payment policy change immediately.”
“As an organization representing physicians who specialize in diagnosing both severe injuries and life-threatening diseases, we are deeply troubled by this latest attempt to undervalue the role of radiologists within the healthcare delivery process,” ACR CEO William T. Thorwarth Jr., MD, wrote April 22. “We believe that the imposition of [a multiple procedure payment reduction] policy to the professional component of diagnostic imaging services will alter the ability of patients to benefit from multiple imaging exams at the same session, and thereby greatly reduce patient access to independent and community hospital-based radiology practices.”
According to Florida Blue, when local providers report the delivery of two or more imaging procedures on one patient, the primary exam is defined as the procedure with the highest relative value unit. This primary exam will be eligible for 100% of the allowance for that procedure, while the reduction applies to the technical and professional component for global services and both only for subsequent exams. Florida Blue—which has 4 million members and serves 15.5 million people in 16 states through its affiliated companies—is applying similar rules to reduce the delivery of cardiovascular and ophthalmology diagnostic procedures.
ACR believes these changes will have a profound impact on radiologists working in small practices or for rural facilities. Oftentimes, such organizations only have enough volume to support a single radiologist, Thorwarth wrote. And this can lead scenarios where patients have multiple imaging exams in clinically separate sessions that must be interpreted by the same radiologist.
“Small practice and rural radiologists are providing a valuable and much needed service to areas of the country that are often in remote locations and should not be penalized for providing efficient care,” Thorwarth concluded. “The ACR is deeply concerned that these cuts to imaging services will greatly undermine our members’ ability to provide high quality patient care. It is important that Florida Blue recognize that these changes to physician reimbursement policy are contrary to appropriate clinical practice and not supported by sound data analysis and, if implemented, will adversely affect patient access.”
ACR also highlighted this issue in a news update shared with members on Wednesday.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.