In 2017, Anthem implemented a new policy that requires outpatient MR and CT scans not considered medically necessary to be completed at a freestanding imaging facility to receive coverage. This went into effect in several states, sparking its fair share of controversy along the way, and a team of Boston-based researchers wanted to know how such a policy could impact patient care in Massachusetts. The group researched the availability of cardiac CT and MRI services at nonhospital outpatient facilities in Massachusetts, sharing their findings in the Journal of the American College of Radiology.
“The number of sites offering an examination may reflect local expertise, practice patterns, and regional demand,” wrote lead author Gabriela Spilberg, MD, department of radiology at Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues. “Although the reasons that underlie these trends are complex, data on the availability of credentialed imaging sites may offer useful insights into the consequences of policies intended to steer patients away from hospital facilities.”
Ghoshhajra et al. wanted to track cardiac CT and MRI services specifically because they are cost effective and growing in popularity. The team started with an American College of Radiology (ACR) database of all ACR-accredited facilities in the state offering both CT and MRI. They then trimmed the list down to facilities that had a cardiac module for each modality and were not based out of a hospital.
Overall, they found only one ACR-accredited non-hospital-based site for cardiac CT and two ACR-accredited non-hospital-based sites for cardiac MRI.
“Limiting access to non-hospital-based facilities for advance cardiac imaging services would have profound consequences in a state with relatively limited access to these services," the authors wrote.