We are a 300-plus bed stand-alone facility that is beginning to feel the sting of payers steering their members from scheduled high-end imaging procedures at our facility to free-standing imaging centers.
Either the payer won’t issue an authorization until patients have received its attempt to steer them to imaging centers, and they still insist on being scheduled at our facility, or the payer offers not to require preauthorizations for the imaging centers or not to require obtaining new orders from physicians. The payer may even represent patients by contacting us and cancelling appointments for them.
How are other hospitals and health systems responding to or reacting to this practice?
Answer: We experienced this with one health plan about a year ago. We would call for authorizations to make the health plan aware that patients had planned imaging procedures, and then the health plan would call patients to steer them elsewhere. Bewildered patients would call us saying they didn’t know what to do.
We pushed back to the health plan, via our contracting staff, pointing out that imaging is part of the specialty cancer care they contract for, and health plan and patients won’t get the same value or outcomes if they try and pull this element out. It stopped. However, Anthem stated they are going to start doing this in several states, so the trend toward this practice will continue.
This question was answered by: Ruth Landé, vice president, patient revenues, Memorial Sloan-Kettering Cancer Center, and a member of HFMA’s Metropolitan New York Chapter.
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