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  • 09.22.11

    Administration Proposals Threaten Patient Access to Medical Imaging

    Administration Proposals Threaten Patient Access to Medical Imaging

    Access to Medical Imaging Coalition Calls on Congress to Reject Reimbursement Cuts & Prior Authorization

    Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) today warned that President Obama’s proposals for reimbursement cuts and prior authorization for advanced medical imaging will obstruct seniors’ access to life-saving diagnostic and therapeutic services.  The proposals to reduce Medicare reimbursements for CT, MRI and PET services and impose prior authorization requirements were included in the President’s deficit reduction plan.

    “We can’t compromise our seniors’ health care and access to timely medical imaging services,” said Tim Trysla, Executive Director of AMIC.  “Additional reimbursement cuts and prior authorization requirements will result in further consolidation of imaging centers, increased wait times and administrative burdens that will prevent patients from getting diagnosed early, when treatment is most effective.  Congress must reject these proposals to protect our seniors.”

    Trysla said there is no scientific research validating whether prior authorization programs achieve cost savings, whereas multiple studies have proven appropriateness criteria effective and successful in driving evidence-based care without compromising patient access.   Additionally, prior authorization often means care is delayed or denied.  A recent American Medical Association survey of 2,400 physicians found that 63 percent said that they typically wait several days for a response to a prior authorization request and 13 percent said they generally wait more than a week.

    Last week, the Delaware Insurance Commissioner announced that it will require Blue Cross Blue Shield of Delaware (BCBSD) to adopt the American College of Cardiology’s (ACC) FOCUS program, based on national medical society-developed appropriate use criteria. The order came on the heels of questions from patients and the media regarding effective delivery of care under BCBSD’s use of prior authorization for cardiac nuclear imaging.

    “Adoption of physician-developed appropriateness criteria is a more effective approach to ensuring that innovative medical imaging technologies are used properly and that patients are able to receive the right scan at the right time,” said Trysla.

    A recent study of Medicare claims data by The Moran Company indicates that cuts to medical imaging have already reduced seniors’ access to advanced medical imaging procedures.  Medicare claims data show that the volume growth in advanced imaging services has been flat since 2007 and the total number of services performed in 2009 was lower than in 2008.  Based on this trend, AMIC cautions that additional cuts and restrictive policies such as prior authorization will further limit the use of advanced imaging services.

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    The Access to Medical Imaging Coalition represents more than 100,000 physicians, medical providers, and patient organizations throughout the U.S. It also includes health technology firms that manufacture imaging equipment and supplies and that employ tens of thousands of workers. Thus, AMIC represents those who develop medical imaging technologies, those who apply it, and those who benefit from it.

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