While the headlines still focus on prescription drug costs, radiology costs have quietly risen to be 10 percent of the healthcare dollar and are growing at a rate of 18 to 20 percent a year, according to HealthLeaders-InterStudy, the leading provider of managed care information to the healthcare industry. By contrast, drug costs, the focus of attention by health plan management, are now growing at 10 percent or less, around half as fast.
"For many health plans, radiology is now driving premium increases," said Jane DuBose, HealthLeaders-InterStudy Associate Director of Health Plan Analysis. "Health plans have worked hard to control drug costs, only to have this new source of costs emerge. Plans are putting new controls on such imaging in place, but we're expecting to see resistance from physicians."
Health plan controls include pre-certification, radiology co-payments, and physician guidelines. Blue Cross Blue Shield of Wisconsin now requires physicians to get pre-approval for some outpatient diagnostic imaging services, including CT and PET scans, MRIs, and Nuclear Cardiology exams. The three largest health plans in Massachusetts have all put stricter pre-authorization requirements into effect.
Not surprisingly, physicians fear the increased administrative burden of complying with the new requirements, which will probably include other controls, like certification or privileging of imaging centers. Many physicians have invested heavily in outpatient facilities, including imaging services. Physicians who own their radiology equipment are two to seven times as likely to order an imaging test as those who don't.
Use of high-tech imaging is likely to increase as the technology improves. HealthLeaders-InterStudy analysts expect to see the healthcare conflicts between cost, capability, and appropriate use, long seen in the arena of prescription drugs, to be played out increasingly in radiology as well.
HealthLeaders-InterStudy, a company of Decision Resources, Inc. (http://www.decisionresources.com/), is the authoritative source for managed care data and analysis. For more information, please visit http://www.healthleaders-interstudy.com/.
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