Brian Tabor, president of the Indiana Hospital Association, said the policy will force doctors to spend less time caring for patients and more time fighting for reimbursement.
It could mean more physicians will likely end up going through a lengthy and convoluted appeals process, increasing administrative costs for hospitals, he said. "A physician's time is being taken away from patient care and refocused on claims adjudication, and that's not good for our healthcare system," Tabor said.
Anthem's imaging program also threatens finances at hospitals when most are already dealing with lower admissions. Five to seven years ago, imaging was "a gold mine" for hospitals, Keckley said. But those services have come under intense scrutiny over the years. Insurers began partnering with radiology benefits management companies to reduce the amount of wasteful diagnostic imaging tests delivered at hospitals and thus, strip out costs. Anthem is partnering with AIM Specialty Health, one of those management firms, to implement its site-of-care program.
It's unclear just how much the average hospital's income is tied to imaging services. While shrinking, several sources said it still accounts for a significant percentage of profit at most systems. Bajner said a few CPT codes for radiology services can make the difference between a large health system recording a profit or loss.
That means imaging services cost insurers a lot of dough. And since MRI prices vary wildly across sites of care, that service line is ripe for medical management.
For example, the price of an MRI of a limb delivered at a hospital averages $1,567, while one provided at a free-standing imaging center costs $504 on average, according to healthcare price transparency company Amino.
Free-standing clinics cut costs because they are providing just one service and therefore have less overhead and much fewer staff, said Rick Anderson, CEO of Chicago-based MRI chain Smart Choice MRI. Hospitals, on the other hand, may have to raise imaging prices to make up for other service lines that are losing money, he said.
Smart Choice has 17 locations total and six in Wisconsin, one of the states affected by Anthem's new policy. Anderson said the Wisconsin locations are already seeing an increase in patient visits, which he attributes to Anthem's program.
"That is a big step in the right direction for the consumer, and I think the payers have finally said: Enough, we're fed up. And Anthem took the lead," Anderson said, adding that the policy is a "win" for independent imaging providers like him, but also for consumers who he said will spend less for the same quality service at a more convenient location. Many experts agree that there's no difference in the quality of imaging services at hospitals and free-standing centers.
Calls to some hospitals affected by the new policy were not returned.
Hospitals should have seen Anthem's policy (or one like it) coming, some experts said. Anthem's policy aligns with what payers have been trying to do for years—push patients toward outpatient, lower-cost settings. Hospitals have been investing more into ambulatory care too. Some have opened their own free-standing imaging centers and could capture Anthem members who are forced to seek imaging services outside of the hospital, said Lea Halim, senior consultant of research with the Advisory Board Co.
The policy is also in line with growing consumer demand for more healthcare options and convenience, driven by the growth in enrollment in high-deductible health plans. While patients could possibly endure delays in care, "in general this is going to be a benefit for patients, assuming they have a place to go," Halim said.
More health insurers are expected to implement broad-based payment policies like Anthem's imaging program as they look for new ways to cut costs, hold down premiums, and make their margins. Navigant's Bajner anticipates that insurers could soon take aim at elective outpatient surgeries and lab services, where there's a big difference in price depending on where the patient goes. Keckley said orthopedic services would be a likely target.
But such policies mark a step backward for the provider-payer relationship, they said. Providers and insurers, which have historically had an adversarial relationship, have become more collaborative through joint ventures and accountable care organizations. Anthem's imaging policy does nothing to further that partnership, Keckley said.
"The impasse between insurers and hospitals is just going to continue to get tougher and tougher," he said, "and this is just one of several areas where (insurers') plans to pursue lower premiums and reduce their expenses are going to become much more aggressive."
Correction: This story was updated Aug. 30 to correct the spelling of Lea Halim's last name.