The Access to Medical Imaging Coalition (AMIC) have called on Congress to reject terms in President Obama’s proposed 2014 budget that would harm patient access to advanced medical imaging technologies that have been proven to save lives through earlier detection and treatment. Specifically, the Administration has prior authorization requirements for advanced imaging in Medicare.
“President Obama’s budget would jeopardize patient access to care and important imaging services through burdensome prior authorization requirements,” said Tim Trysla, Executive Director of AMIC. “These policy recommendations are not supported by data, and ultimately, physicians, patients and caregivers will pay the price.”
Utilization of imaging services within Medicare has declined substantially since 2006, a downward trend that has been twice confirmed by the Medicare Payment Advisory Commission (MedPAC), which noted in its March 2012 Report to Congress that imaging represents the slowest growing category in the fee-for-service Medicare program. Despite this trend line clearly showing reductions in the growth rate for imaging utilization, Congress reduced Medicare payment rates for imaging yet again in January 2013, marking the twelfth time that Medicare’s imaging reimbursement has been cut in the past seven years.
Meanwhile, there has been no scientific, peer-reviewed research on the safety, efficacy or impact on administrative costs of prior authorization and radiology benefits managers (RBMs). In fact, 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. Another study, commissioned by the Patient Advocate Foundation in April 2012 explored the impact of health coverage denials on patients seeking medical imaging exams, ultimately finding that, of the 4,360 patients who contacted PAF between 2007 and 2011 for help in accessing the test they needed, 81 percent of the insurance denials for imaging procedures were due to prior authorization programs – and 90 percent of the denials reversed were in fact covered by the patients’ health plans.
“Implementation of a prior authorization program will not only produce zero cost savings, it will insert an artificial middle-man between physicians and their patients,” said Trysla. “As an alternative to this misguided policy proposal, AMIC supports the adoption of physician-developed appropriateness criteria and the use of decision support tools, both of which have proven effective in driving appropriate imaging use without compromising patient access to the right scan at the right time.”
AMIC – Access to Medical Imaging Coalition