By March 1, 2008, otolaryngologists offering point-of-care CT scanning-and who are UnitedHealthcare providers-must initiate accreditation of their diagnostic facilities. One of the nation’s largest insurers, UnitedHealthcare has instituted a quality initiative for all medical imaging facilities providing MR, CT, PET, nuclear medicine, and echocardiography exams to adopt accreditation programs as a requirement for reimbursement. Industry observers believe it is likely that other major carriers will soon follow suit and also establish accreditation as a reimbursement requirement.
Explore this issue:
February 2008But even if otolaryngologists are not currently UnitedHealthcare providers, obtaining accreditation for the operation of their diagnostic equipment makes good sense. Accreditation, said Gavin Setzen, MD, of Albany ENT and Allergy Services in Albany, NY, is one additional checkpoint that allows the practice to ensure appropriate and quality testing. He considers the accreditation process absolutely critical for otolaryngologists who are considering point-of-service CT. One has to determine if this is a viable business model for implementation in one’s own practice, based on economic factors and clinical patient and payer mix, he said. Obtaining accreditation allows one the opportunity to reevaluate how CT imaging is provided within one’s office. The goal, at the end of the day, is to ensure that one can preserve point-of-service care and provide an optimal patient experience that is safe, effective, and of the highest quality.
Tamara A. Sloper, Director of Marketing with the Intersocietal Accreditation Commission (IAC), which offers a new program for accrediting in-office CT scans of the sinus and temporal bone, believes that despite requirements for accreditation by third-party payers such as UnitedHealthcare, accreditation stands alone as a worthy endeavor. Any provider of the imaging services that we accredit is very much encouraged to go through the accreditation process voluntarily, as a mechanism for demonstrating their quality, to undergo peer review, and for a multitude of reasons way beyond just the reimbursement issue, she said.
For Part 2 of this series on point-of-care diagnostics, we will focus on accreditation issues, whereas Part 3 will address legal and regulatory issues of offering in-office diagnostics.
Utilization Concerns
Otolaryngologists whom we interviewed for both parts 1 and 2 of this series have found that point-of-care CT scanning improves patient care and is also cost-effective (see part 1 in the January issue of ENT Today). But with the growth of the new, compact volume/cone beam scanners, insurers are understandably concerned about rising utilization rates. Manufacturers’ marketing efforts, especially those that tout otolaryngology-specific CT scanners as a route to increase practice revenues, may serve to increase those concerns, some believe. In the current economic and regulatory climate, it is imperative for otolaryngologists (and all physicians) to adhere to appropriate utilization standards for CT and other diagnostic modalities, asserted Dr. Setzen. A recent survey in the Annals of Internal Medicine indicated that physicians do not always follow professional guidelines for ordering diagnostics. For example, one-third of surveyed physicians reported they would accommodate patient requests for a test (such as an MRI) that they knew was unnecessary.1