If you’re a single speciality primary care group or even a multi-speciality group without your own imaging center, consider buying your imaging studies in bulk from an outside vendor and then using them on the patients in your panel as the need arises.
Check your Medicare Advantage contract, but many will allow you to service your patient outside your contract without charge.
If yours does not, ask your insurance partner about amending your agreement, it’s in their interest to do so.
Many testing vendors will give steep discounts for bulk purchases with up-front payment. Most will limit your purchase to a given time period. If you don’t use the tests you purchase, they’ll be lost. You can minimize this by using your own utilization data to determine how many exams to buy.
We did this in our practice before we purchased our own MRI machine and the impact on our performance was impressive.
Even with a 50-50 risk-share with your Medicare Advantage Organization, you can save money with this approach. Simply apportion the cost of each exam to the prime who ordered it as if they ordered the test through the insurance contract and deduct the funds from their pool payment at the time they are reconciled.
There’s no time wasted on pre-certs, the patient has no co-pay, and the clinicians develop an enhanced sense of autonomy.
It’s a care-deliver innovation where everybody wins.