CAC News
MANAGED CARE COMMITTEE REPORT
As has been the theme of the last 2 reports, the focus on imaging in Massachusetts and nationwide continues to be on the cost of health care with an emphasis on high tech imaging.
The preauthorization programs run by Blue Cross/Blue Shield (BC/BS), Tufts Health Plan (TAHP), and Harvard Pilgrim Health Care (HPHC) and other peripheral insurers are well entrenched in this state and show no signs of being discontinued. HPHC has presented follow up data to the Task Force on Cost Control for the Massachusetts Medical Society and has shown that their preauthorization plan has had the desired effect in slowing the growth and cost of high tech imaging. Updates from BC/BS and TAHP are pending.
As of 1 January, 2008, BC/BS has introduced a radiology copayment program in Massachusetts. TAHP will be doing something similar on a limited basis. This will apply to the technical component of high tech imaging. The exact impact of this program on the radiology community at the time of writing is unknown but will evolve as the year progresses.
In the fall of 2007, BC/BS issued a Medical Policy update notifying the radiology community that as of January, 2008, CAD for digital mammography would no longer be a covered benefit, in concordance with their national policy. Representatives of the Massachusetts Radiological Society met with BC/BS in December to discuss this change in payment policy. Following the meeting, BC/BS has notified us that this change in payment policy will not be implemented and CAD for digital mammography will continue to be a covered benefit. I believe this illustrates that when our concerns are appropriate, the health plans are open to constructive dialogue and we can have an impact on the implementation of policy change. My thanks goes to Phyllis Kornguth MD, Alan Semine MD and Robyn Birdwell MD who were instrumental in facilitating this dialogue.
On a federal level, there is little good news. The DRA is entrenched and any attempts at reversal have not had the desired results.
The Medicare Physician Fee Schedule for 2008 includes a 0.1% increase for the first 6 months of 2008. A 10.1% reduction is slated to be implemented as of July 1. Hopefully this will not transpire as the year progresses.
Cardiac CTA remains in the development phase with respect to reimbursement. BC/BS and TAHP do not cover cardiac CTA. HPHC covers 1 of the 8 level 111 codes. As of January 2008, CMS has issued a National Coverage Decision (NCD) proposal that cardiac CTA will only be covered for 2 indications and only as part of a trial. This will supersede the local carrier decision (LCD) that allowed payment for cardiac CTA throughout the country (including Massachusetts). At this time, it therefore seems likely that cardiac CTA will no longer be reimbursed by CMS except as outlined above. It is safe to assume that the private insurers will likely follow CMS policy in the near future.
Once again, as 2008 begins, our economic and regulatory future is uncertain. In general however, radiology continues to thrive and should do so into the future.
Respectfully submitted,
Philip Rogoff, MD
Chair, Managed Care Sub-Committee