MedPAC Formally Recommends Pre-Authorizations For Some Imaging Services

Today, the Medicare Payment Advisory Commission (MedPAC)  recommended that Congress require pre-authorizations for some imaging services, consistent with its proposed recommendations from last month.

MedPAC suggested indentifying individual physicians who are "outliers," who seem to use more imaging than their peers and offering those individuals re-education. If the re-education doesn't stick, Medicare could require pre-authorization for their imaging orders.

The Medical Imaging & Technology Alliance (MITA) responded, calling on Congress to reject the recommendations.

“While MedPAC has confirmed that the growth in utilization of advanced imaging services was flat from 2008 to 2009, it continues to recommend dramatic reimbursement cuts as well as a prior authorization program that would result in reducing seniors’ access to imaging services,” said Dave Fisher, Executive Director of MITA. “MedPAC’s has chosen to disregard the very imaging use data it confirms.  Deep cuts to imaging service that are not growing will impede patients’ access to imaging services which are central to the standard of medical care.”

MedPAC did report in March that the use of patient imaging in Medicare grew by nearly 10% every year from 2004 to 2008.

MITA pointed out that cutting reimbursements to physicians in office settings has the potential to encourage physicians to refer their Medicare patients to higher cost hospital settings and has the potential to seriously impact provision of x-rays and ultrasound services to Medicare patients.

MITA further referred to a study in the June 2011 issue of the Journal of the American College of Radiology (JACR) that found that relying on Radiology Benefit Managers (RBMs) to conduct prior authorization for advanced imaging increases costs and red tape.