Minnesota payors restrict imaging procedures

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Dec. 4—The number of imaging scans performed in Minnesota has decreased due to new restrictions placed by state insurance companies, preventing procedures that appear wasteful, unnecessary, or procedures that weren’t recommended by the ACR, according to the St. Paul Pioneer Press.

“We think this gets to most of the overuse in imaging," said Charles Fazio, MD, chief medical officer for Medica, a Minneapolis-based health insurer. He said that doctors are making fewer requests for imaging scans based on the decision.

In March, Medica began discouraging doctors from imaging procedures that were not recommended by the ACR, reported Pioneer Press. Since that time, the insurer said the rate of high-tech scans for its 1.3 million members has decreased by 10 percent, as well as the number of imaging requests that fall outside of medical guidelines.

According to Pioneer Press, healthcare officials are disputing whether the restrictions have healed or harmed the medical system. However, insurers anticipate millions of dollars in cost savings, which they said, “should lower healthcare premiums for everyone.” Meanwhile, doctors believe their time is wasted and they are losing money when they have to call insurers for permission to run tests, reported the Pioneer Press.

“It's purely economically driven," said Joe Tashjian, MD, president of St. Paul Radiology, a private practice of radiologists. "It wouldn't be genuine [for insurers] to say it's all based on science and that they're doing this for scientific reasons but on the other hand, they're right in that there were scans being performed that weren't indicated.”

Insurance executives and physicians are working together to develop a centralized system that would give physicians immediate and consistent advice on whether a scan would be covered, which would limit the "lost time and hassle" of the current system and save money for insurers because they would not need to hire contractors to evaluate physician requests, according to the Pioneer Press.