Issue link: https://beckershealthcare.uberflip.com/i/904318
47 OUTPATIENT SURGERY Anthem Policy Drives Outpatient Imaging Services Out of Hospital-Owned Facilities; Will Other Services Follow? By Laura Dyrda A new Anthem policy that took effect July 1 for local plan members in In- diana, Kentucky, Missouri and Wis- consin drives patients who need outpatient imaging services to freestanding facilities. e policy went into effect for members covered in Ohio on Sept. 1. Under the new policy, AIM Specialty Health began reviewing the requested level of care for imaging services; patients admitted to the hospital will be covered for outpatient imaging services at hospital-owned facilities, but all other requests for outpatient imaging will be steered toward freestanding centers. Members who undergo outpatient imaging services at hospital-owned facilities deemed medically unnecessary in the setting will be responsible for the entire bill. Pediatric patients are included in the new policy and will be driven to freestanding im- aging centers that meet criteria for pediatric patients if they are available; if not, pediatric patients will be able to undergo outpatient imaging at hospital-owned facilities. Outpatient imaging services at freestanding facilities are typically less expensive than the same services at hospital-based facilities, meaning members that pay a percentage of the overall cost out-of-pocket could see re- duced costs; members with facility copay plans likely won't see a reduction in their out- of-pocket expenses. Anthem Blue Cross Blue Shield of Missouri Senior Clinical Director Jay Moore, MD, told the St. Louis Dispatch the insurer saw cost dif- ferential of around 500 percent between the hospital-owned and freestanding facilities. e new policy could decrease spending on outpatient imaging services. In the past year, Anthem stopped paying for "unnecessary" emergency room visits, in- cluding those for the common cold or sore throat, in select states. Instead, the insurer in- structed customers to seek care in lower cost settings such as urgent care facilities. e St. Louis Dispatch hinted the payer could take further steps to rein in costs, which could in- clude driving care such as surgery to the most cost-effective setting. Other payers may be moving in that direction as well; RAC Monitor reports a memo from Humana notified providers earlier this year that 145 surgeries on the inpatient-only list could now be performed in the ASC for Hu- mana Medicare Advantage patients, includ- ing total knee and hip replacements, cervical spine fusion and carotid artery stenting. n learn more at titanSpine.com and #StandWiththeFuture in Fact, We're obSeSSed With it. by mimicking natural bone, our nanolock ® SurFace technology iS able to begin the mechaniSmS oF bone groWth the moment it haS been implanted. brought to you by titan Spine, naturally. N A T U R A L L Y. W E K N O W B O N E, Copyright © , 2015 Titan Spine, LLC