Ratcheting down imaging costs

Health plans have been somewhat slow in trying to bring diagnostic imaging costs under control. But there’s a move under way to require prior approval for outpatient CT and MRI scans. It harkens back to the bad old days of managed care but with the amount of money at stake it’s surprising we haven’t seen more. Blue Cross Blue Shield of Wisconsin is the latest health plan to announce this policy, according to the Business Journal of Milwaukee. They will be using American Imaging Management (AIM) to help on this front.

Mostly, the plans will disallow requests that don’t conform to American College of Radiology guidelines. Physicians could save themselves the trouble by following the guidelines themselves or relying on a system such as SafeMed that can support their decision making and keep the AIM folks off their backs.

December 22, 2005

2 thoughts on “Ratcheting down imaging costs”

  1. A recent study by HealthLeaders predicts that radiology utilization management is the next “cost battlegound” between health plans and providers. It doesnt have to be this way. Other radiology utilization management solutions are coming to market that are more provider and patient-friendly that cut radiology spending without causing the payer-provider friction that the radiology benefit management firms are seeing.

  2. This is very true, we do not need a battleground. Better solutions which are integrated with the workflow of physicians and care providers such as the one provided by http://www.diagnosisone.com can do a much better job. Stand alone systems don’t stand a chance and physician acceptance has been zero.

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