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  • 10.18.11

    New Analysis Finds Lack of Cost Savings and Efficacy Data Associated with Prior Authorization

    Access to Medical Imaging Coalition Calls on Congress to Reject Prior Authorization and Explore Proven Approaches to Managing Utilization

    Washington, D.C. – Policy proposals to adopt prior authorization for advanced medical imaging as a means of controlling utilization would not provide meaningful cost savings, according to a new literature review by The Moran Company. The report, released today by the Access to Medical Imaging Coalition (AMIC), evaluated the cost savings of various proposed imaging policies and found that the Congressional Budget Office (CBO) is unlikely to score significant savings for these strategies.

    “The analysis confirms that a prior authorization policy for the Medicare program would not achieve any real cost savings,” said Tim Trysla, executive director of AMIC. “Contrary to outdated budget estimates being used by some members of Congress, a prior authorization program would end up costing the government more than it saves and would simply delay patient care and impose administrative burdens and increased costs on physician practices. Further, as the Department of Health and Human Services has cautioned, there is no independent data demonstrating radiology benefit managers’ success, their black box protocols are not consistent with the Medicare program, and it would be ineffective and costly to deny services only to have the denials overturned on appeal.”

    “Our review of the literature found surprisingly little information on the impact of prior authorization, and our analysis suggests that the returns from such a program may be meaningfully smaller than its operating costs,” said Don Moran, president of The Moran Company.  “Policymakers may, instead, wish to consider the possibility of using decision support systems, which the evidence suggests can be effective means of managing imaging utilization when they are available.”

    This analysis comes on the heels of recent research illustrating a downward trend in imaging use: an earlier 2011 study by The Moran Company found that in 2009 the overall volume of imaging services delivered to Medicare beneficiaries declined for the first time in 11 years. In light of this trend, AMIC cautions that prior authorization by radiology benefit managers (RBMs) will only further hinder access to life-saving diagnostic imaging services.

    “We are seriously concerned about RBMs compromising patient access to timely medical imaging services,” said Trysla. “The Moran analysis confirms that policymakers should be looking elsewhere for cost savings.  The adoption of physician-developed appropriateness criteria and the use of decision support tools promote cooperation among physicians and are far more effective approaches to ensuring that patients receive the right scan at the right time.”

    “Prior authorization takes medical decisions out of the physician’s hands, creating additional hurdles between patients and crucial diagnostic imaging services,” said Bibb Allen, M.D., a member of the American College of Radiology (ACR) Board of Chancellors. “Health care decisions should be made by physicians and their patients, not by third parties whose priority is reducing spending.”

    Andrew Spiegel, CEO of the Colon Cancer Alliance, echoed Trysla’s remarks.  “Early detection saves lives and money. No one should be denied the right to a longer, healthier life because of a bureaucratic decision. The Colon Cancer Alliance encourages more policymakers to pursue alternative approaches to managing utilization of advanced medical imaging services so that colon cancer patients are not denied access to scans that may save their lives.”

    To view the Moran study, please click here.

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