Health Insurers, Physicians Raise Concerns About Cost, Safety Of Advanced Medical Scans

Main Category: MRI / PET / Ultrasound
Also Included In: Primary Care / General Practice;  Health Insurance / Medical Insurance;  Radiology / Nuclear Medicine
Article Date: 26 Mar 2008 - 8:00 PDT

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Health insurers have begun "taking a harder look at advanced medical scans, like CT scans," because of cost and safety concerns, and some physicians "agree there's emerging evidence that these scans are being over-prescribed," the AP/San Francisco Chronicle reports. According to the AP/Chronicle, health insurers have begun to require more preauthorizations for such medical scans -- as well as implement other restrictions, such as a requirement of advanced accreditation for the machines used to conduct the scans and the health care professionals who operate them -- in part because they "fear some patients are being exposed to dangerous radiation levels from having repeated CT and PET scans, which use many times the radiation of a regular chest X-ray."

Physicians also have concerns about patient exposure to radiation from such medical scans, which often are not needed or are ordered as "defensive medicine" to protect against possible medical malpractice lawsuits. "There also is concern that a small number of unscrupulous doctors without adequate expertise are referring patients for tests in their own offices or imaging facilities in which they have a financial interest," the AP/Chronicle reports.

Karen Ignagni, CEO of America's Health Insurance Plans, said, "Costs are soaring in this area, quality concerns are mounting and safety concerns are mounting."

Robert Hendel, a heart specialist who serves on American College of Cardiology committees focused on quality and appropriateness of such medical scans, said, "There is a definite concern that in-office imaging could lead to scanning for dollars."

However, Arl Van Moore, board chair for the American College of Radiology, raised concerns about increased restrictions on such medical scans implemented by health insurers. "Is this a preauthorization process, or are these (insurance) companies practicing medicine?" he asked (Johnson, AP/San Francisco Chronicle, 3/24).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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