UnitedHealthcare cutting radiology group pay rates in bid to preserve affordability
UnitedHealthcare is reportedly cutting radiology groups’ pay rates in a bid to preserve healthcare affordability.
Healthcare consultant Ron Howrigon highlighted the news in a social media post Tuesday, noting the country’s largest commercial insurer collected $14.4 billion in net earnings last year. This represented a roughly 35% decline from the $22 billion collected in 2023, impacted by the Change Healthcare cyberattack and rising medical costs, among other factors.
“So, to help plug that hole they are unilaterally decreasing reimbursement to radiologists,” wrote Howrigon, president and CEO of Fulcrum Strategies, noting that radiologists’ pay in the Medicare program has plummeted when factoring for inflation. “Well, who cares about that? Daddy needs his bonus, so let's just take a bunch of money from the radiologists,” he added.
Howrigon shared an example of a letter one of his radiology group clients received from United on Sept. 15, with the name of the recipient redacted. In it, the Minnetonka, Minnesota-based payer wrote: “Rapidly rising healthcare costs continue to be a top concern for members and their employers.” To address this issue and “offer more affordable and predictable” choices, UnitedHealthcare is regularly updating fee schedules to “align with current reimbursement standards.”
As a result of this review, the unidentified radiology group will see a new fee schedule from UHC, updated to match RVUs (relative value units) used by the Centers for Medicare & Medicaid Services in 2024. “This change captures several industry updates to work and practice expense values for services,” UnitedHealthcare wrote, adding that the change does not affect fees paid by noncommercial plans such as Medicare Advantage.
“What are your options when you get this letter? Well, you can reject this unilateral change and then you are out of network with UHC and have to go through the [No Surprises Act’s independent dispute resolution] process,” Howrigon added. “Lovely, just lovely. Another warm fuzzy from the good people at UHC.”
Asked to respond to the social media post, a UnitedHealthcare representative said the company is periodically updating some providers’ fee schedules “as part of our commitment to making healthcare more affordable.” This is meant to ensure it is reimbursing in-network physicians at “fair, market-competitive rates for the care they provide.”
“Some providers see increases in reimbursement rates, while others see decreases,” the representative told Radiology Business Tuesday. “When reimbursement rates are reduced, it’s often because a provider’s rates are markedly higher than the market-competitive rate we pay other physicians in their market who deliver the same services.”
Howrigon’s social media update had received over 50 responses and 10 reposts by the end of Tuesday. His consulting firm lists 50-plus radiology groups on its past and present clients list. One respondent asked whether it is private equity-backed imaging groups that are seeing their rates cut by UnitedHealthcare. The payer has battled with such entities recently in court, including an ongoing, high-profile case filed against Radiology Partners, the largest imaging practice in the U.S. Howrigon responded saying the five he is aware of, which are seeing their rates cut by UHC, are all independents.
“Can the radiologists decide to void the contract? Other radiologist groups have done so with this company. More need to do so it seems,” responded Tarang Patel, DO, co-founder and CEO of Radiology One, a recently launched independent imaging group.
“Where one company goes, the others will follow. This is inexcusable but has become the new reality of practice. Hold your hats,” wrote Lee Rubin, MD, an associate professor of orthopedic surgery at Yale University.
“Why do we this in our country? Why do we allow greedy corporations to put profits over people? Why do we allow for-profit sectors to lobby (bribe) our politicians? Gosh I just don’t get it. Naively bewildered as someone who cares about humanity,” added Sheri Mancini, MD, a general surgeon with the Allegheny Health Network.
“They’re all doing it. And then patients get frustrated when everything is ‘out of network,’” wrote Graham Walker, MD an ER doc with the Permanente Medical Group, noting that Cigna also has implemented a policy of down-coding complex visits and cutting pay for physicians.
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.