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  • 10.5.11

    BCBSA Proposal Threatens Patient Access to Medical Imaging

    AMIC Calls on Congress to Reject Delaware-Style Prior Authorization & Preserve Patient Access

    Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) today called on Congress to reject the Blue Cross Blue Shield Association’s (BCBSA) recommendation that Congress impose prior authorization as a gatekeeper for Medicare beneficiaries seeking to access advanced medical imaging services.  AMIC cautioned that prior authorization is an ineffective and unproven mechanism for encouraging appropriate imaging utilization and likely will result in denying seniors’ access to life-saving diagnostic and therapeutic services.

    The BCBSA proposal comes on the heels of Blue Cross Blue Shield of Delaware’s (BCBSD) failed attempt to impose prior authorization requirements on patients.  Following intense scrutiny of the quality of BCBSD’s delivery of care under its prior authorization program for cardiac nuclear imaging, BCBSD was ordered by the Delaware Insurance Commissioner to scrap prior authorization and instead use the American College of Cardiology’s (ACC) FOCUS program.

    “It’s ironic that Blue Cross Blue Shield of Delaware was taken to task by the state insurance commissioner for denying patient care as a result of using prior authorization for imaging services, yet their national association chooses to advocate that Medicare adopt a similar scheme,” said Tim Trysla, Executive Director of AMIC.   “The Delaware Insurance Commissioner’s decision underscores the ineffectiveness and negative consequences of prior authorization and it would be irresponsible to enact these tools more broadly.”

    “There is not a single peer-reviewed, evidence-based study that shows prior authorization programs for medical imaging achieve any real cost savings. However, multiple studies have shown that alternatives to prior authorization like physician-developed appropriateness criteria and decision support tools effectively drive appropriate imaging use without compromising patient access,” said Trysla. “No matter how loudly private payers advocate for prior authorization, Congress and CMS cannot ignore the data: prior authorization for advanced imaging doesn’t work and will actually cost taxpayers more.”

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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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