The Medical Imaging & Technology Alliance (MITA) has recently expressed concern about President Obama’s proposed 2014 budget, which again includes a recommendation for a prior authorization system through for-profit radiology benefit managers (RBMs).
This provision was included in spite of the Office of Management and Budget (OMB)’s acknowledgement that a prior authorization policy will yield no savings. According to MITA, if instituted, this proposal will jeopardize both innovation and patient access to imaging technologies that have proven time and again to save lives and lower long-term healthcare costs.
“Though we appreciate President Obama’s desire to improve the Medicare program, policies that impede patient access to diagnostic imaging would only serve to increase long-term healthcare costs through unneeded treatments and hospital stays,” Gail Rodriguez, executive director of MITA, said in a statement. “Instead, MITA urges the administration to work with Congress to pursue alternative, evidence-based solutions to guide proper use of imaging services, such as encouraging the adoption of physician-developed appropriateness criteria.”
Several recent independent analyses have shown a decline in utilization of imaging technologies. The Medicare Payment Advisory Commission’s (MedPAC) annual report to Congress in March 2012 confirmed that imaging services fell by 2.5 percent in 2010, while non-imaging utilization increased 2 percent. These data are consistent with an analysis commissioned by MITA which found that Medicare spending per beneficiary in the field has dropped 13.2 percent since 2006 and imaging utilization declined by 3 percent. This contrasts markedly with the overall Medicare program, in which spending per beneficiary increased by 20 percent and non-imaging utilization rose by 2 percent.
Research shows that prior authorization programs for medical imaging services not only create an artificial barrier between patients and their doctors but can also lead to significant delays or inappropriate denials of coverage. For example, a study in the June 2011 issue of the Journal of the American College of Radiology found that relying on RBMs to conduct prior authorization for advanced imaging increases costs and red tape, placing a burden on physicians and potentially causing delays in treatment.