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 (AP) - Medica instituted on Monday the requirement for doctors to check
with a third-party evaluator employed by the insurer. Next month,
HealthPartners will do so. Blue Cross and Blue Shield of Minnesota
will follow among in July.

      Insurers say the policy is way to reduce the number of CT scans,
MRIs and other high-tech imaging procedures that are wrongly or
unnecessarily prescribed, but doctors are tepid about the
requirement because, they say, it means more work without more pay.

      "We pay for 170,000 scans a year, and if 10 percent to 15
percent are wrong scans or unnecessary, that's a lot of scans,"
said Dr. Charles Fazio, Medica's chief medical officer. "And
that's a lot of health care costs."

      At an average of $700 per scan, Medica estimates that it will
see a savings of at least $12 million this year. HealthPartners
claims to expect $7 million in savings.

      The new rule will not affect low-tech imaging, including X-rays,
nor will it affect inpatient care, urgent care or emergencies.
Instead it applies to outpatient scans.

      Dr. Robert Meiches, chief executive of the Minnesota Medical
Association, said the new requirement takes time from doctors' busy
schedules without any financial returns.

      "Medica is addressing an important issue but is placing an
extra burden on physicians without extra reimbursement," he said.

      He said doctors follow test guidelines the majority of the time,
but they also need flexibility in prescribing scans "because each
situation has to be individualized."

      In the HealthPartners and Medica programs, individual doctors
will have final say on the imaging procedure, and HealthPartners
will reimburse them even if their decision is different from the
one advised by the consultant.

      Magnetic resonance imaging, or MRI, is used more for soft-tissue
examinations, such as the brain. Positron emission tomography, or
PET, scans can be used to trace the results of therapy on cancers.

Computerized tomography, or CT, scans use special X-ray equipment
to show a cross-section of body tissue and organs, and can be used
to look for conditions such as cancer or cardiovascular diseases.

      The popularity of these scans, and others, have been growing in
Minnesota. According to the American College of Radiology, MRI use
in state doctors' offices grew at twice the national average
between 1998 and 2003. CT and PET scans grew at a rate triple the
national average. And that doesn't include specialized imaging
centers.

      A report by the Minnesota Council of Health Plans recently found
that insurers paid $188.9 million for CT and MRI scans last year,
up 13 percent from 2004.

      "This is one of those things that everyone acknowledges is an
issue that we have to address," said Dr. Pat Courneya, associate
medical director for HealthPartners. "With the right information,
people will work to make good decisions."

      Physicians treating Medica patents under the new requirement
must call the insurer's third-party consultant when ordering a
high-tech scan to make sure it is appropriate.

      The radiology management consultant, who is not necessarily a
medical doctor, can agree with the doctor or recommend another
procedure. Medica says the telephone call should take an average of
five minutes, but doctors doubt it will be that fast.

      "I'm not unaware of the problems (health) plans are facing with
the rising cost of imaging," said Dr. Joseph Tashjian, a
radiologist and president of St. Paul Radiology. "The
authorization process is a punitive process and not as helpful in
furthering the goal" of creating a more uniform system for
decision-making.

      St. Paul Radiology employs nearly 90 radiologists who work at five imaging centers and 11 hospitals, making it the largest
business of its kind in the state. 

Gallery

Health

Medica has already instituted the requirement that doctors check with a third-party evaluator before ordering a CT scan or MRI.  Other large insurers are expected to follow suit later this year.

State's insurers want a second opinion before approving scans

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