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.

“We are concerned that additional reimbursement cuts and proposals such as prior authorization will result in reduced access and longer wait times for our seniors and greater administrative burdens on our physicians,” said Tim Trysla, executive director for AMIC. “Patients and providers have joined together to ensure that Congress understands the risks of further reducing Medicare payments for life-saving diagnostic imaging services and using RBMs, which have never been proven effective, to deny imaging services.  This is a groundswell that Congress can’t ignore.”

In a letter to the chairmen and ranking members of the committees with jurisdiction over federal health care programs, the chairs of the Joint Select Committee on Deficit Reduction, and House and Senate leadership, AMIC and the 21 patient advocacy and professional organizations expressed concern about the prior authorization and reimbursement policies under consideration:

• Prior authorization, or radiology benefit managers (RBMs), in Medicare would directly block patient access to care and impose huge administrative burdens on providers and the Medicare program while never having been proven effective through independent research.
• Further reducing Medicare payments will continue to reduce access to imaging services in the community as centers and physician practices consolidate or close, leading to long wait times for an appointment and longer driving distances to the nearest imaging center or hospital.

Since the Deficit Reduction Act of 2005, Medicare payments for medical imaging services have been reduced repeatedly, with some cuts yet to be fully implemented. By 2013, many key services will have been cut by more than half.  For example, an MRI of the brain will have been cut by 60.7 percent by 2013. Payments for even a simple chest x-ray will have been cut nearly 25 percent by 2013.

“The most recent Medicare claims data show that imaging spending and utilization are flat and suggest access problems for important services like mammography and bone density scans,” Trysla continued. “Additional cuts to imaging reimbursement and an unprecedented and unproven prior authorization program would only further impede beneficiaries’ access to care.”

A recent literature review by The Moran Company of prior authorization as a method of controlling imaging utilization found no independent validation of the effectiveness of RBMs and revealed that a prior authorization program in Medicare would be unlikely to yield any budgetary savings.

The letter was signed by the Access to Medical Imaging Coalition (AMIC), American Brain Tumor Association, American College of Nuclear Medicine, American Pain Foundation, Association of University Radiologists, Bladder Cancer Advocacy Network, Coalition for Pulmonary Fibrosis, Colon Cancer Alliance, COLONTOWN, Community Oncology Alliance, Hypertrophic Cardiomyopathy Association, Lung Cancer Alliance, Patient Advocates for Advanced Cancer Treatments, Radiological Society of North America, Society of Chairs of Academic Radiology, Sarcoma Foundation of America, Society of Interventional Radiology, Society for Nuclear Medicine, Sudden Cardiac Arrest Association, Us TOO International Prostate Cancer Education & Support Network, YES! Beat Liver Tumors and ZERO: The Project to End Prostate Cancer.

The full letter can be found here.

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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.

]]> http://rightscanrighttime.org/2011/11/access-to-medical-imaging-coalition-and-23-groups-call-on-congress-to-oppose-rbms-and-payment-cuts-to-medical-imaging-services-for-seniors/feed/ 0 http://rightscanrighttime.org/2011/10/new-analysis-finds-lack-of-cost-savings-and-efficacy-data-associated-with-prior-authorization-2/ http://rightscanrighttime.org/2011/10/new-analysis-finds-lack-of-cost-savings-and-efficacy-data-associated-with-prior-authorization-2/#comments Tue, 18 Oct 2011 17:49:15 +0000 pt-admin http://rightscanrighttime.org/?p=3010 Access to Medical Imaging Coalition Calls on Congress to Reject Prior Authorization and Explore Proven Approaches to Managing Utilization

Washington, D.C. – Policy proposals to adopt prior authorization for advanced medical imaging as a means of controlling utilization would not provide meaningful cost savings, according to a new literature review by The Moran Company. The report, released today by the Access to Medical Imaging Coalition (AMIC), evaluated the cost savings of various proposed imaging policies and found that the Congressional Budget Office (CBO) is unlikely to score significant savings for these strategies.

“The analysis confirms that a prior authorization policy for the Medicare program would not achieve any real cost savings,” said Tim Trysla, executive director of AMIC. “Contrary to outdated budget estimates being used by some members of Congress, a prior authorization program would end up costing the government more than it saves and would simply delay patient care and impose administrative burdens and increased costs on physician practices. Further, as the Department of Health and Human Services has cautioned, there is no independent data demonstrating radiology benefit managers’ success, their black box protocols are not consistent with the Medicare program, and it would be ineffective and costly to deny services only to have the denials overturned on appeal.”

“Our review of the literature found surprisingly little information on the impact of prior authorization, and our analysis suggests that the returns from such a program may be meaningfully smaller than its operating costs,” said Don Moran, president of The Moran Company.  “Policymakers may, instead, wish to consider the possibility of using decision support systems, which the evidence suggests can be effective means of managing imaging utilization when they are available.”

This analysis comes on the heels of recent research illustrating a downward trend in imaging use: an earlier 2011 study by The Moran Company found that in 2009 the overall volume of imaging services delivered to Medicare beneficiaries declined for the first time in 11 years. In light of this trend, AMIC cautions that prior authorization by radiology benefit managers (RBMs) will only further hinder access to life-saving diagnostic imaging services.

“We are seriously concerned about RBMs compromising patient access to timely medical imaging services,” said Trysla. “The Moran analysis confirms that policymakers should be looking elsewhere for cost savings.  The adoption of physician-developed appropriateness criteria and the use of decision support tools promote cooperation among physicians and are far more effective approaches to ensuring that patients receive the right scan at the right time.”

“Prior authorization takes medical decisions out of the physician’s hands, creating additional hurdles between patients and crucial diagnostic imaging services,” said Bibb Allen, M.D., a member of the American College of Radiology (ACR) Board of Chancellors. “Health care decisions should be made by physicians and their patients, not by third parties whose priority is reducing spending.”

Andrew Spiegel, CEO of the Colon Cancer Alliance, echoed Trysla’s remarks.  “Early detection saves lives and money. No one should be denied the right to a longer, healthier life because of a bureaucratic decision. The Colon Cancer Alliance encourages more policymakers to pursue alternative approaches to managing utilization of advanced medical imaging services so that colon cancer patients are not denied access to scans that may save their lives.”

To view the Moran study, please click here.

Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) today called on Congress to reject the Blue Cross Blue Shield Association’s (BCBSA) recommendation that Congress impose prior authorization as a gatekeeper for Medicare beneficiaries seeking to access advanced medical imaging services.  AMIC cautioned that prior authorization is an ineffective and unproven mechanism for encouraging appropriate imaging utilization and likely will result in denying seniors’ access to life-saving diagnostic and therapeutic services.

The BCBSA proposal comes on the heels of Blue Cross Blue Shield of Delaware’s (BCBSD) failed attempt to impose prior authorization requirements on patients.  Following intense scrutiny of the quality of BCBSD’s delivery of care under its prior authorization program for cardiac nuclear imaging, BCBSD was ordered by the Delaware Insurance Commissioner to scrap prior authorization and instead use the American College of Cardiology’s (ACC) FOCUS program.

“It’s ironic that Blue Cross Blue Shield of Delaware was taken to task by the state insurance commissioner for denying patient care as a result of using prior authorization for imaging services, yet their national association chooses to advocate that Medicare adopt a similar scheme,” said Tim Trysla, Executive Director of AMIC.   “The Delaware Insurance Commissioner’s decision underscores the ineffectiveness and negative consequences of prior authorization and it would be irresponsible to enact these tools more broadly.”

“There is not a single peer-reviewed, evidence-based study that shows prior authorization programs for medical imaging achieve any real cost savings. However, multiple studies have shown that alternatives to prior authorization like physician-developed appropriateness criteria and decision support tools effectively drive appropriate imaging use without compromising patient access,” said Trysla. “No matter how loudly private payers advocate for prior authorization, Congress and CMS cannot ignore the data: prior authorization for advanced imaging doesn’t work and will actually cost taxpayers more.”

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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.

Access to Medical Imaging Coalition Calls on Congress to Reject Reimbursement Cuts & Prior Authorization

Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) today warned that President Obama’s proposals for reimbursement cuts and prior authorization for advanced medical imaging will obstruct seniors’ access to life-saving diagnostic and therapeutic services.  The proposals to reduce Medicare reimbursements for CT, MRI and PET services and impose prior authorization requirements were included in the President’s deficit reduction plan.

“We can’t compromise our seniors’ health care and access to timely medical imaging services,” said Tim Trysla, Executive Director of AMIC.  “Additional reimbursement cuts and prior authorization requirements will result in further consolidation of imaging centers, increased wait times and administrative burdens that will prevent patients from getting diagnosed early, when treatment is most effective.  Congress must reject these proposals to protect our seniors.”

Trysla said there is no scientific research validating whether prior authorization programs achieve cost savings, whereas multiple studies have proven appropriateness criteria effective and successful in driving evidence-based care without compromising patient access.   Additionally, prior authorization often means care is delayed or denied.  A recent American Medical Association survey of 2,400 physicians found that 63 percent said that they typically wait several days for a response to a prior authorization request and 13 percent said they generally wait more than a week.

Last week, the Delaware Insurance Commissioner announced that it will require Blue Cross Blue Shield of Delaware (BCBSD) to adopt the American College of Cardiology’s (ACC) FOCUS program, based on national medical society-developed appropriate use criteria. The order came on the heels of questions from patients and the media regarding effective delivery of care under BCBSD’s use of prior authorization for cardiac nuclear imaging.

“Adoption of physician-developed appropriateness criteria is a more effective approach to ensuring that innovative medical imaging technologies are used properly and that patients are able to receive the right scan at the right time,” said Trysla.

A recent study of Medicare claims data by The Moran Company indicates that cuts to medical imaging have already reduced seniors’ access to advanced medical imaging procedures.  Medicare claims data show that the volume growth in advanced imaging services has been flat since 2007 and the total number of services performed in 2009 was lower than in 2008.  Based on this trend, AMIC cautions that additional cuts and restrictive policies such as prior authorization will further limit the use of advanced 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.

Washington D.C. – The Access to Medical Imaging Coalition (AMIC) today applauded the decision of the Delaware Insurance Commissioner requiring Blue Cross Blue Shield of Delaware (BCBSD) to adopt the American College of Cardiology’s (ACC) FOCUS program, based on national medical society-developed appropriate use criteria. The order comes on the heels of questions from patients and the media regarding effective delivery of care under BCBSD’s use of prior authorization for cardiac nuclear imaging via radiology benefit managers (RBM), which were used as a gatekeeper for access to medical imaging.

“Prior authorization and radiology benefit managers that prevent patients from receiving lifesaving and timely care are of serious concern to us,” said Tim Trysla, Executive Director of AMIC. “AMIC has long advocated the adoption of national medical society-developed appropriate use criteria to ensure proper utilization of innovative medical imaging technologies and help physicians make clinically effective decisions about the care their patients receive.”

Trysla also noted that there is no research showing that RBMs achieve the long term cost savings that proponents claim they do. Rather, prior authorization often simply means delaying or denying care.  In a recent American Medical Association survey of 2,400 physicians, 63 percent said that they typically wait several days for a response to a prior authorization request and 13 percent said they generally wait more than a week.  Alternatively, appropriate use criteria programs using clinical decision support and education have proven effective and successful in driving quality care without compromising patient access, across a host of medical settings and studies.

“This decision reinforces what so many patients and physicians already know: that RBMs and other prior authorization systems are administrative burdens that impede patient access to care. It is unfortunate that patients needed to take their case to the press to receive the scans they need,” said Trysla.

“Yesterday’s decision by the Delaware Insurance Commissioner will help doctors to make appropriate decisions regarding care and drive down costs, while still ensuring that patients are able to access the right scan at the right time,” said Trysla.

For more information about the ACC’s FOCUS program in Delaware please click here.

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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.

Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) today said that despite acknowledging that advanced imaging services growth is flat, the Medicare Payment Advisory Commission’s (MedPAC) recommendations to reduce reimbursements for CT, MRI and PET services and impose prior authorization requirements will reduce patients’ access to life-saving diagnostic and therapeutic services.  AMIC called on Congress to reject the recommendations.

“Patients affected by cancers, heart disease and other conditions for which an early diagnosis is critical to their health and survival should take notice that MedPAC is shutting the door on patients and the benefits of medical imaging,” said Tim Trysla, Executive Director of AMIC.  “Even though MedPAC has acknowledged that the most recent Medicare claims data show that advanced imaging spending and volume are flat, they are recommending further cuts to imaging reimbursement and an unprecedented prior authorization program that would, by definition, impede beneficiaries’ access to care.”

Trysla said there is no scientific research validating the clinical quality of radiology benefit managers (RBMs) or whether they truly achieve cost savings or merely shift costs, whereas there are numerous peer-reviewed articles supporting the use of advanced imaging studies.  ”RBMs are not accountable or transparent to the public, and their proprietary algorithms deny or delay care without any peer-reviewed clinical evidence showing they are safe,” said Trysla.

AMIC and several patient advocacy groups recently wrote to MedPAC to oppose the recommendations. (Letter available here.)

A recent study of Medicare claims data by The Moran Company indicates that cuts to medical imaging may already be disrupting seniors’ access to important advanced medical imaging procedures.  From 2008 to 2009, use of advanced medical imaging procedures fell by 0.1 percent, the first decrease in 11 years studied, including volume decreases of 1.2 percent in MRI services, 0.3 percent in screening mammography and 2.2 percent in bone density (DEXA) scans.

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Access to Medical Imaging Coalition (AMIC) Cautions Against Further Threats to Patient Access

Washington, D.C. – The volume of advanced imaging services delivered to Medicare beneficiaries decreased in 2009 for the first time in 11 years, according to a new analysis by The Moran Company.  The study, released today by the Access to Medical Imaging Coalition (AMIC), a coalition of physician, patient and imaging manufacturer groups, found that while the volume of advanced imaging services decreased by .1 percent, the amount of overall imaging services declined by 7.1 percent.

“The analysis found that Medicare spending for advanced imaging services increased by less than half the spending growth for physician services overall,” said Don Moran, president of The Moran Company. “With a 1.2 percent increase in spending for advanced imaging compared with 2.6 percent for services overall, imaging was one of the slowest growing segments of the physician fee schedule in 2009.”

Moran’s analysis of Medicare claims data from 1999 through 2009 examined both the spending and volume of advanced imaging services – specifically CT, MRI and Nuclear Medicine including PET – as well as overall imaging services, including mammography.  The new findings are comparable to a 2008 analysis of Medicare claims data that showed a 19.2 percent reduction in Medicare spending on advanced imaging from 2006 to 2007 and revealed a significantly reduced volume growth rate of only 1.9 percent, which was less than the overall rate of physician-payment growth.

“The decline in volume of critical screening services suggests that access issues are at hand,” said Tim Trysla, executive director of AMIC.  “While imaging has been proven to reduce mortality, additional cuts to Medicare reimbursements threaten to continue the current trajectory and further restrict patient access to life-saving diagnostic tools and screening services.”

The new analysis also found that the total volume of mammography screenings decreased by .3 percent in 2009, compared to a 2.8 percent compound annual growth rate in the past decade. Additionally, the total volume of dual-emission X-ray absorptiometry (DXA), which measures bone mineral density, decreased by 2.2 percent, while spending decreased by 16 percent from 2008-2009.

In the face of this downward trend in imaging use, Congress and government agencies have continued to limit the use of advanced imaging services by cutting Medicare reimbursements and making recommendations that restrict patients’ access to them.  The implication of these policies may include fewer services available for Medicare beneficiaries, longer wait times, and difficulty in diagnosing patients early, when treatment is most effective.

“Advanced imaging is a critical tool for the early detection of disease, which is directly related to beneficial outcomes and extension of lives,” said John A. Patti, MD, chair of the American College of Radiology Board of Chancellors.  “The trend of reduced volume of imaging among Medicare beneficiaries is a concern for doctors who rely on these services to ensure optimal care for their patients.”

Mark F. Victor, MD, vice president of medical affairs for the Cardiology Advocacy Alliance agreed, noting, “Cardiac patients can’t afford lengthy delays in diagnosis and treatment due to limited access to diagnostic imaging tools. It is essential that our policies put our patients first.”

On Monday, President Obama is scheduled to deliver his budget proposal for fiscal year 2012.   As Congress considers spending for the coming year, Trysla said, “We encourage policymakers to consider the value of medical imaging in saving lives and preserving quality of life, while preventing higher health care costs over the long term.”

To view the Moran study executive summary please click here.

Click here to read the statement.