UnitedHealthcare Accreditation Mandate: Why They Did It

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Last January, UnitedHealthcare, Edina, Minn, became the first insurer in America to require nationwide accreditation for all outpatient-imaging providers, effective March 2008. The mandate applies equally to all outpatient providers of MRI, CT, PET, nuclear medicine, nuclear cardiology, and echocardiography. Providers have a choice of being accredited by the American College of Radiology (ACR) or the Intersocietal Accreditation Commission (IAC).

Why did United Healthcare—supported enthusiastically by the ACR—make the move?

“We believe that our program addresses the quality and safety of imaging through the application of nationally recognized standards,” answered Laurie Paidosh, director, radiology programs, UnitedHealthcare. “It assures that the imaging equipment, physicians, and the technologists are in compliance with the appropriate performance standards. So bottom line, our goal is to advance the safety and quality of imaging services.

Not Too Late

It is not too late for imaging providers to apply for accreditation in time to meet UnitedHealthcare’s condition for reimbursement, through the American College of Radiology (ACR) or the Intersocietal Accreditation Commission (IAC) beginning March 2008. Imaging providers may seek accreditation from the ACR or the IAC.

“It’s not too late for people to take action,” Laurie Paidosh, director, radiology programs, UnitedHealthcare, reassured. The insurer has mandated that all providers who bill under the CMS 1500 form be officially in the accreditation process by March 1, 2008.

According to the latest information on the ACR web site, the college requires the submission of a completed application by January 15, 2008, in order to ensure that the application will be processed by the March 1 deadline.

The broader story is that many of the factors driving the increased utilization of imaging drove UnitedHealthcare to action, according to Paidosh.

The recognition of significant variation in the delivery of health care. “First and foremost, UH recognized that significant variations existed, and still exist today, in the quality, safety, and appropriate utilization of imaging services in health care delivery,” Paidosh explained. “So we know from evidence-based literature and professional society guidance that these variations affect…the quality, safety, as well as affordability of health care. We were really acting on behalf of our customers in terms of developing an initiative that could address those elements.”

Growing consumer demand for imaging. “If you are a Baby Boomer, you are much more savvy about health care,” Paidosh noted. “The other piece is the direct-to-consumer advertising that occurs—get your heart study today, find out if you have clogged arteries—venturing out where the pharmaceuticals have been. You are seeing some of that now in imaging.”

Greater access to imaging technology. “The next driver of increased imaging spend is greater access to imaging technology, meaning more non-radiologists have access to imaging technology,” Paidosh added. “It could be for patient convenience, it could be an economic factor, meaning there is an incentive, but you’ve got non-radiology specialists who are doing it, and it does lead to an increase in utilization.”

Advances in imaging technology and technology applications. “New technology is growing significantly, and appropriately so,” Paidosh said. “New developments have made it very useful in terms of being able to diagnose more accurately, and with that you have new applications of existing technologies and new technologies that have come into play, PET being the most recent. The challenge for the referring physician is how to know what is the most appropriate study to use? Is it the CT, the MRI?”

Widespread utilization of technology by providers. “Everyone is doing a little imaging, it is no longer necessarily concentrated in a few specialties,” Paidosh said. “Twenty years ago, most imaging was delivered either in a radiologist’s office or in a hospital setting. That has changed dramatically today in terms of having technology in physicians’ offices, mobile units, as well as outpatient hospital centers and freestanding radiology centers. So there has been a shift in the traditional environment.”

In implementing its accreditation program, UnitedHealthcare is attempting to balance its challenges and opportunities, Paidosh said, challenges that include rapid and sustained growth, the widespread use and availability