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  • 12.16.11

    Access to Medical Imaging Coalition Calls on Congress to Reject Prior Authorization Proposals for Medical Imaging

    Radiology Benefit Managers Threaten Patient Access, Lack Data to Show Cost Savings or Efficacy Data

    Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) called on Congress today to reject proposals from the radiology benefits management industry to implement prior authorization for outpatient medical imaging in the Medicare program as a means of controlling costs. Although radiology benefits managers (RBMs) have been used in the private sector for 10 years, there has been no scientific, peer-reviewed research on their safety, efficacy or impact on administrative costs. In fact, a recent AMIC literature review found that policy proposals to adopt prior authorization for medical imaging, including RBMs, would not provide meaningful cost savings.

    “Proposals to adopt RBMs for medical imaging in the Medicare program are misguided and threaten patient access to timely diagnostic imaging services,” said Tim Trysla, executive director of AMIC. “Our analysis confirms that a prior authorization policy would end up costing the government more than it saves, while imposing administrative burdens and increased costs on physician practices.  We encourage Congress to reject these proposals and focus on evidence-based alternatives that support physician choice, protect patient safety and preserve access to care.”

    AMIC supports the adoption of physician-developed appropriateness criteria and the use of decision support tools, which are approaches that have proven effective in ensuring that patients receive the right scan at the right time. In September, the Delaware Insurance Commissioner required Blue Cross Blue Shield of Delaware (BCBSD) to adopt national medical society-developed appropriate use criteria instead of RBMs, following concerns from patients and the media regarding compromised access to care under BCBSD’s use of RBMs for cardiac nuclear imaging.

    Meanwhile, new reports have confirmed that medical imaging is not increasing health care costs.  Just yesterday, the Medicare Payment Advisory Commission (MedPAC) said that imaging use in 2010 decreased by 2.5 percent.  This confirms a recent Medical Imaging & Technology Alliance analysis of 2010 Medicare claims data, indicating a downward trend in both imaging spending and utilization.  In light of these trends, AMIC cautions that prior authorization by RBMs will only further hinder access to life-saving diagnostic 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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