To the chagrin of imaging advocates, a Government Accountability Office study has found that preauthorization may be best way for Medicare to slow the rapid growth of outpatient MR, CT, and other high-tech imaging services.
To the chagrin of imaging advocates, a Government Accountability Office study has found that preauthorization may be best way for Medicare to slow the rapid growth of outpatient MR, CT, and other high-tech imaging services. The June 2008 report confirmed findings of a 2005 Medicare Payment Advisory Commission study that singled out high-tech medical imaging as the fastest growing component of physician services covered by Medicare Part B. The MedPAC report is widely cited for influencing congressional reforms in the Deficit Reduction Act of 2005 that substantially cut Medicare outpatient rates for high-tech medical imaging.Sen. John D. Rockefeller IV (D-WV), chair of the Senate Finance Subcommittee on Health, and Gordon H. Smith (R-OR), ranking member of the Senate Special Committee on Aging, asked the GAO to reexamine the MedPAC investigation and management practices that private payers use to regulate imaging spending.
The GAO findings included the following:
The GAO found fault with Centers for Medicare and Medicaid Services cost-control policies that focused on provider billing fraud following the provision of imaging services. It urged CMS to redirect its cost-control efforts to constrain spending growth on the front end of imaging, specifically the patient referral practices of physician-owned in-office imaging facilities. The GAO noted that private insurance plans have successfully used prior authorization to slow the growth of imaging-related spending. It also cited physician credentialing to restrict equipment use to qualified practitioners and physician profiling, a statistical technique that identifies high-utilization physicians.
The reactions of imaging advocates to the report ranged from disappointment to anger.American College of Radiology officials agreed with the report's findings but disagreed with the GAO about its preauthorization recommendation. The ACR prefers mandatory facility accreditation as a less intrusive approach. Congress adopted mandatory accreditation for MR, CT, and PET, and other modalities in Medicare-related legislation passed in mid-July. Dr. James H. Thrall, ACR Board of Chancellors chair, said in a statement that cost and quality concerns should be dealt with directly and not through third parties."Why spend more taxpayer dollars to hire outside entities to examine claims on an individual basis, possibly delaying legitimate exams?" he said.The recommendations outraged the Access to Medical Imaging Coalition, a consortium of professional associations and device manufacturers groups,"I can't even say this report is half-baked, because I don't even think that it was ready to put in the oven," said Timothy P. Trysla, executive director of AMIC. Trysla was disappointed that the GAO chose to ignore other quality assurance policies enacted by private insurers. As of July 1, United Healthcare, for example, began requiring MRI, CT, PET, nuclear medicine/cardiology, and echocardiography providers to pursue accreditation through the ACR or the Intersocietal Accreditation Commission.Trysla also pointed to a GAO admission in the report that the Department of Health and Human Services had raised concerns about the administrative burden of implementing prior authorization and its applicability to the federal insurance program.The Medical Imaging & Technology Alliance, a division of the National Electrical Manufacturers Association, faulted the report for ignoring recent data, reference medical guidelines, and evidence of appropriateness and accreditation criteria used by providers and payers. "The GAO report obscures how medical imaging utilization decisions are made and the benefit that imaging has to healthcare savings and patient outcomes," said Andrew Whitman, MITA vice president.For more information from the Diagnostic Imaging archives:
Proponents hail passage of Medicare bill as triumph for physicians, patients
Universal coverage may mean practice changes
CMS decision didn't come out of the blue
Medicare imaging costs skyrocket, draw scrutiny
Can Photon-Counting CT Have an Impact in Diagnosing Congenital Heart Defects in Young Children?May 29th 2023
Photon-counting computed tomography (PCCT) significantly increased the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) in comparison to dual-source CT (DSCT) at similar radiation dosing, according to a new study of over 100 children with suspected congenital heart defects.
The Reading Room Podcast: Emerging Trends in the Radiology WorkforceFebruary 11th 2022
Richard Duszak, MD, and Mina Makary, MD, discuss a number of issues, ranging from demographic trends and NPRPs to physician burnout and medical student recruitment, that figure to impact the radiology workforce now and in the near future.
FDA Clears Conditional MRI Use for Implantable Sleep Apnea SystemMay 26th 2023
Conditional use of full-body magnetic resonance imaging (MRI) is reportedly permitted for patients using any of the models for the remede® System, an implantable nerve stimulation therapy indicated for the treatment of adults with moderate to severe central sleep apnea.
Multicenter Breast Ultrasound Study: AI Bolsters Accuracy and Specificity of BI-RADS ClassificationsMay 24th 2023
Emerging breast ultrasound research showed the use of computer-aided diagnosis (CAD), powered by deep learning, led to 24 percent and 36.9 percent improvements in accuracy and specificity, respectively, in the use of BI-RADS classifications by radiologists without breast ultrasound expertise.
Digital Mammography Meta-Analysis Suggests AI Performs as Well as RadiologistsMay 24th 2023
Six reader studies on digital mammography revealed a pooled sensitivity rate of 80.8 percent for stand-alone artificial intelligence (AI) in comparison to 72.4 percent for radiologist assessment while seven historic cohort studies showed a 75.8 percent pooled sensitivity rate for stand-alone AI versus 72.6 percent for radiologist interpretation of digital mammography.
2 Clarke Drive
Cranbury, NJ 08512