As an example of an insurance provider trying to take health costs into its own hands, a health plan in Minnesota early this month launched a new plan to reduce the number of very costly imaging procedures it pays for, which of course has been an unpopular move with physicians and radiologists, the St. Paul Pioneer Press reports.
Medica, which is the second leading health plan in the state, announced that doctors must get its clearance before ordering outpatient imaging scans for individuals within their plan.
"When third-party payers make decisions about the care a patient may get, they are practicing medicine without a license," said Michael Gonzalez-Campoy, MD, an endocrinologist and past president of the Minnesota Medical Association, told the paper. "They are hurting patients, and it is costing you and me money."
Obviously the insurers don’t agree, and view this as a viable way to bring down the $189 million insurers dolled out for imaging procedures in 2005, a 13 percent rise from 2004, according to the Minnesota Council of Health Plans, St. Paul Pioneer Press reports.
Medica is not alone. Other big insurance companies in the state such as HealthPartners and Blue Cross and Blue Shield are similar rules to their plans soon. From Medica’s perspective, many of the imaging exams that are ordered in the state are needless and also don’t adhere to ACR (American College of Radiology) rules. Using a CT scan when a more cost-effective x-ray would suffice is an example given by one Medica exec of system abuse and needless expensive, the St. Paul Pioneer Press reports.
Some doctors in the state view the process as highly intrusive, and wrong to take decision making power away from them and into the hands of insurers. Some others that have already tried the system have stated that it is not nearly as time consuming or difficult as they had assumed.
It remains to be seen if, once fully implemented, if such a system will have wings in the state or if it will face considerable revision down the road.
The new system will be voluntary until March.