Thursday, August 31, 2017

Anthem Announces It Will Stop Paying for Imaging in Hospital Outpatient Centers

Hospital outpatient imaging can cost more than imaging in freestanding centers - by a lot.  An article in Modern Healthcare (here) gives typical outpatient hospital MRI prices as $1500, and freestanding prices as $500, and the delta is much larger in some states.

Anthem has an answer.  It isn't steeper discounts when it pays for hospital outpatient imaging.  Rather, it's a "blunt instrument."   Anthem won't pay for hospital outpatient imaging at all.   (See an article in Radiology Business, here, and in Healthcare Dive, here and also here (9/18).)

CMS has also proposed cuts for services at off-campus "hospital" outpatient centers, e.g. satellite physician clinics some distance from the actual hospital, here.

This could be an bad omen for the expansion and profitability of hospital outpatient/outreach labs that bill payers as "hospitals" at much higher prices than freestanding labs can get.