Imaging Center Roundtable, part 1
I'm here in room 1 of the Imaging Center Roundtable (so popular they had to give it two rooms!). The objectives of the discussion are giving people the opportunity to share their wisdom on submitted questions, relying on the “collective brainpower of the room.” In order, I'll relate the submitted questions and some of the answers. Preauth, Stark, technical service agreements and much much more, after the jump . . . Q: How many imaging center providers here today have technical service agreements with referring physician practices? If not, are you being approached to do these? A: We don't do these arrangements, but the other group in town does, so it causes a problem. It definitely makes those physicians send their business to the other group. I wish it were illegal A: Our competitors are running low-quality magnets. We're being pressured to go there and won't do it. I agree that it should be deemed illegal. Moderator: Blue Cross Blue Shield New Jersey is about to disallow orthopedists, urologists, primary care doctors to have in-office imaging. Anyone else? No? I guess New Jersey’s lucky. Q: Can imaging centers perform pre-auth for referring physicians as part of the referral, or is this a gray area as far as Stark is concerned? A: In our case, we’re a medical billing company, and we have clients who keep doing this. Their marketing folks think the easier they can make it for the referring physician, the more likely they are to send their business to the center. Moderator: For those of you doing the preauths, is it authorized by the payor? A: Yes (echoed around the room). A: I’m not sure I agree with the position that there’s a Stark issue here. I’m not sure it’s settled. There are people in the industry who continue to do it. It’s clearly a marketing issue and a service to the referring physicians. I’m not convinced it’s a Stark issue, but you do need to pay attention to the payors’ side. Moderator: This is an issue for all of us. What can we do to better address the situation? Do we need to sit down with the payors as a unified front? It’s a policy they have that is concerning us. We didn’t create this nightmare, but we’re taking the hit. Anyone work out a solution they’re willing to share with the group? A: I don’t have any great breakthrough, but I think the solution to this lies in a strong statement from the RBMA and the ACR. The foundation on which these RBMs are built is cracked. They’re not after the 2% that are denials. We’ve looked forward to replacing RBMs with guidance from the radiology community. The RBMs aren’t going to go away otherwise, and if we continue to collude with them, I think they will be here to stay. I call on RBMA and ACR to make a strong statement that radiologists should be doing this work with referring physicians. A: I have a question about that. For those of you, even if you were able to get your referring physicians to get the preauth for you, wouldn’t you verify it anyway, so wouldn’t it wind up being double the work? A: We do both. It’s a constant eroding of relationships between us and the referrings. That’s what we deal with, trying to keep that relationship good. A: I think we’re missing the point here. We’re not in the middle of this, the patient is in the middle of this, and I think we’re losing sight of that. Moderator: Is anyone else building appropriateness criteria as part of their education for referring doctors? A: We have checked, triple-checked, overviewed. Our goal is to take care of the patient. Period. All those things we’re doing are to benefit the patient. There’s no difference to some of these people between a hip and an elbow, so we’re going back and doing the work anyway, contacting that provider when the patient’s sitting in our lobby waiting. The patient is the one caught in the middle. We’re doing everything on our end to help that patient get the test the doctor’s requested. As someone who’s been dealing with this issue in Arizona for close to ten years now, I bet no one could tell you with a straight face that they don’t have a staff member who is strictly obtaining authorizations on a daily basis. We’re here for the patient. We’re just trying to facilitate the order that came to our office. And it’s not strictly monetary. It’s quality of care. These are the issues we deal with every day. Until we formally address this issue, all we’re doing is rallying around the fact that yes, it’s happening, it’s a gray area. Unless everyone rallies together and puts out a formal document on what should be done, this will continue to be a problem. Moderator: By the way, CareCore says the ACR appropriateness criteria is not strict enough, so I don’t see that necessarily as the answer to replace RBMs. A: The problem we’ve had is that our employees are asked, are you an employee of the referring physician? When they say no we’re not, the RBM says we can’t talk to you. What can we do? A: I know a provider that says no, we’re not, but we’re calling on behalf of . . . A: If we get those, we call the referring doctor back and say you’re going to have to get this yourself. A: Working in this business before and now, half of your claims would be denied and you wouldn’t know until three months later. We now get auth, we get the right tests, we get the patient done the right time. I don’t have those same customer complaints anymore. Our customer satisfaction has gone through the roof, so if you look at it that way, we’re doing the right thing for the patient. We’re talking with the business office now where we never used to. Whether we like it or not, doing the auth is patient-centric, so I can’t blame them for making us do it. A: What is the ACR and RBMA’s position on this? Do they have one? If the ACR isn’t taking a position, this will continue to be a problem. Moderator: I’ll attempt to answer that question. I believe the position of RBMA is that we support a decision support system for physicians. We’d rather not see the RBMs interfere. We want the decision made at the physician level, not by some company that’s taking twenty cents per member per month. A lot of work and effort has gone into this, and we’re going to continue to push for the decision support system. RBMA has a white paper and you can access that on our website. To be continued in part 2!