Lawmakers are urging Hawaii Medical Service Association and its doctors to come to a compromise on a controversial new HMSA policy requiring doctors to get pre-authorization from a mainland company before ordering imaging tests for patients.
HMSA began requiring on Dec. 1 all physicians in its network to go through a third party, Arizona-based National Imaging Associates Inc., to approve diagnostic imaging exams — including MRIs, computerized tomography (CT) scans and other cardiac-related procedures — in an effort to avoid unnecessary procedures and reduce costs. Before the new policy, most doctors were given a waiver, known as a gold card, that allowed them to skip the pre-authorization step.
The policy change resulted in complaints that HMSA’s new process is delaying critical imaging tests, resulting in harmful consequences for patients. House Bill 2740, introduced after the Honolulu Star-Advertiser published a story about the policy, aims to ban requirements that cause “undue delay in receipt of medical treatment or services” and specifies that insurers would be liable for civil damages caused by any holdups for pre-authorization.
“In health care, moments really do matter,” said Dr. Scott McCaffrey, president of the Hawaii Medical Association, representing 1,100 physicians, at a Thursday hearing before the Senate Commerce, Consumer Protection and Health Committee. “It is the reason for 911, ambulances and emergency rooms, and nothing should ever delay the physician’s ability to reach early, accurate diagnoses.”
Dr. Mark Mugiishi, HMSA’s chief medical officer, said that the policy is necessary as Hawaii’s imaging utilization costs are about 9 percent higher than the national average in the commercial market for people who have insurance through their employers.
Other research shows that the state’s imaging rate for Medicare, the government health insurance program for seniors, was 33 percent lower than the national rate in 2014 — the second lowest in the nation, according to the Hawaii Health Information Corp., a nonprofit that analyzes local health care data.
“Pre-authorization programs for advanced imaging are commonplace,” Mugiishi said, “because advanced imaging has become a problem of over-utilization in our country and something that really does need to be addressed so that we can spend our health care dollars on things that really matter and are necessary for our population.”
HMSA has restored waivers for 22 out of the 58 providers in the state who order more than one imaging test per day, Mugiishi told lawmakers. HMSA has more than 2,000 doctors in its network.
Sen. Roz Baker, chairwoman of the Senate Commerce, Consumer Protection and Health Committee, has asked HMSA and its doctors to reach a compromise before a decision is made on the bill.
Physicians who testified at the hearing agreed that imaging tests should be screened for medical appropriateness, but they are hoping to work with HMSA on how to make the process more efficient.
One suggestion is for doctors to use software to immediately determine whether a test is necessary rather than waiting for a mainland company to make a determination. Another idea is to allow the Hawaii Medical Association and the American College of Radiology to help assess the screening process locally to reduce delays in imaging exams.
In a private meeting after the hearing, HMSA agreed to meet with the Hawaii Medical Association and its physicians to work out a possible compromise, said Dr. Scott Grosskreutz, a Hilo radiologist, who was in the closed-door session.
“The physicians are hopeful after meeting with HMSA that we can find a better way to approve tests so that there are no longer delays in patient care,” he said.
