Insurer sets facility accreditation as imaging standard

The UnitedHealth Group, serving 70 million individuals nationwide, announced today it will require facilities in all 50 states to be accredited by next year. The move is a step in the right direction, but insurers need to go farther, say some radiologists.

The accreditation program focuses on facilities that perform CT and CTA, MRI and MRA, nuclear medicine and nuclear cardiology, PET, and echocardiography services in freestanding outpatient facilities and physician offices.

"Quality is always necessary for optimal patient care, but there are two other components insurers need to consider as well," said Dr. Alan Kaye, a member of the American College of Radiology steering committee on appropriateness criteria.

Along with an emphasis on good quality, payers should ensure that patients receive the appropriate examination for the clinical situation and that the exam is ordered for no other reason except to get the information that benefits the patient. In other words, without inappropriate self-referral, Kaye said.

While UnitedHealth's mandate touches all 50 states, other insurers have introduced similar protocols but with a more limited reach. Last year, Anthem Blue Cross Blue Shield of Indiana, Kentucky, and Ohio initiated accreditation restrictions for providers of MRI, nuclear medicine, nuclear cardiology, and PET.

Blue Cross Blue Shield of Kansas City in 2006 introduced a privileging program, which included among other requirements that CT and/or MR be performed at a practice site that provides at least three radiology modalities.

Highmark Blue Cross Blue Shield of Pennsylvania initiated a similar privileging program as the Kansas City program in 2004 for all of Western and Central Pennsylvania. Anthem Blue Cross Blue Shield of Connecticut specified that outpatient imaging centers need to be wholly owned by hospitals, radiologists, or both.

"Let's hope that after UnitedHealth roles out its accreditation program that it will also initiate steps to ensure appropriateness and then begin a privileging program," said Kaye, who chairs the radiology department at Bridgeport Hospital in Connecticut.

UnitedHealth, headquartered in Minneapolis, MN, has teamed with the American College of Radiology and the Intersocietal Accreditation Commission to facilitate accreditation for its network of contracted imaging physicians.

Facilities must be accredited by March 1, 2008. The length of time needed to prepare an application varies. ACR and ICA therefore suggest that facilities seeking to meet the new requirements submit accreditation applications by June 1, 2007.

For more information from the Diagnostic Imaging archives:

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