Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Radiology Family Feud: Brinkmanship to the Rescue

  When insurance companies pit radiologists against radiologists, Brinkmanship saves the day.

 On Friday, December 8, I and other ACR members received an e-mail message from ACR Board of Chancellors Chair James A. Brink, MD, FACR. In it Dr. Brink mentions the recent policy by health insurance company Anthem to use coverage denials to steer patients away from hospital-based outpatient radiology departments for advanced imaging studies, particularly MRI and CT, and toward "preferred" facilities, i.e. lower-cost free-standing imaging centers.

Apparently, the ACR's opposition to Anthem's policy has resulted in a member backlash. Framing the ACR position as favoritism, some radiologists have taken up arms in the form of writing letters to the ACR to express their displeasure. In the January 2018 issue of JACR, Dr. Brink's column explains the ACR's position opposing Anthem's policy, using a fitting Hatfields and McCoys feud analogy. These few sentences from the article best encapsulate the ACR position:

All ACR members are stakeholders in the Anthem decision, no matter who appears to benefit or be disadvantaged. By my read, it's actually Anthem, not the ACR, that has picked winners (not surprisingly, Anthem and its shareholders) and losers (radiologists, referring providers, and patients, also no surprise). I envision a dark corner room filled with Anthem bigwigs, stealthily hatching their policy plan, certain that the ACR will take the bait to defend its members. Sniggering corporate honchos are delighted at the discord they've sown, throwing back popcorn as they watch radiologist pitted against radiologist, battling to the finish like gladiators for whatever measly reimbursement crumbs are tossed their way. Admittedly, I've painted an overly dramatic and conspiratorial picture, but it was Anthem's policy that triggered this whole kerfuffle in the first place.

Companies like Anthem are financial entities that manage healthcare premium collection and disbursement. Increasingly, they are also trying to dictate the allocation of resources within the healthcare sector and among individual patients. True, the rising cost of healthcare means that improved healthcare delivery efficiency and other cost saving measures are continually being sought. However, those who make decisions that directly or indirectly impact healthcare resource utilization have an obligation to conform to ethical standards to be fair, equitable, efficient, and wise. We as radiologists, both as individuals and collectively, should strive to meet those ethical standards. Those standards should also be a yardstick against which insurance company policies are measured and held accountable.

A definition of brinkmanship is "the practice of trying to achieve an advantageous outcome by pushing dangerous events to the brink of active conflict." Brexit, the United Kingdom's recent experiment with brinkmanship, isn't exactly turning out to be a quick, tidy, and congenial breakup with the European Union. We too are now dangling over the edge of a precipice, with a choice between splintering into factions or uniting against an external menace.

Let's direct our collective animus at forces that tear at the fabric of radiologist-patient, radiologist-referring provider, and radiologist-radiologist relationships to achieve a satisfactory result for all stakeholders and to mitigate the unintended (or perhaps, more cynically, the intended) consequences of Anthem's decision.

I hereby propose a new definition of brinkmanship, with the caveat that the term begin with an upper case letter "b," i.e. Brinkmanship: the practice of a radiology medical association leader trying to de-escalate a situation among members on the brink of conflict caused by a provocative third party. Here's hoping Brinkmanship pulls us back from the verge of an epic self-defeating mistake.

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