Coalition Highlights New Study on Impact of Reduced Payments on Screening Use

Washington, D.C. – The Medicare Payment Advisory Commission (MedPAC) must consider the potential downstream impact on beneficiaries’ access and health outcomes when advising Congress about physician payments, the Access to Medical Imaging Coalition (AMIC) said today.  In a letter to MedPAC, AMIC highlighted a new study on dual energy x-ray absorptiometry (DXA) screenings for osteoporosis that illustrates the correlation between inadequate Medicare reimbursement and adverse patient outcomes.

“This study demonstrates the very real impact of Medicare payment cuts on the health and safety of patients, which has been AMIC’s primary concern since the Deficit Reduction Act,” said Tim Trysla, executive director of AMIC.  “Congress and CMS cannot continue to recklessly cut Medicare imaging payments in order to meet short term budget goals without closely examining how it will affect patients’ health over the long term.”

The peer-reviewed study, published in the December 2011 issue of Health Affairs, found that DXA testing in all Medicare Part B settings plateaued in 2007-2009 after the Deficit Reduction Act of 2005 (DRA) and regulations cut Part B imaging payments, following a decade of growth in the use of DXA to detect osteoporosis. According to the study, in those years, 800,000 fewer tests than expected were performed for Medicare beneficiaries—tests that might have prevented 12,000 fractures and their associated health care costs.

“Bottom line, had the rates not been cut, we would not have seen that devastating number of fractures,” said Donna Fiorentino, co-author of the Health Affairs study.  “What’s frustrating is that prevention for this disease is centered around DXA testing.  The screenings are inexpensive, incredibly accurate and great at predicting the disease. We’ve seen all the statistics.  These tests, coupled with appropriate medications, can get people back to the point where their bone is healthy, avoiding unnecessary fractures.”

AMIC members have expressed concern that repeated legislative and regulatory cuts to medical imaging reimbursement since 2006 have led to growing access problems for DXA and other imaging modalities.  In fact, overall per-beneficiary imaging use declined by 2.5 percent in 2010 according to a recent analysis by the Medical Imaging & Technology Alliance (MITA) that was affirmed by MedPAC last month.  While other physician services have continued to grow in volume, medical imaging use has fallen.

Read AMIC’s letter to MedPAC.

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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) 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.