Feature | March 06, 2014

ACR: President’s Budget Would Curtail Imaging and Radiation Oncology Self-Referral

Prior authorization provision would burden providers, restrict access

American College of Radiology ACR CT Systems Imaging

March 6, 2014 — The American College of Radiology applauded steps to reign in medical imaging and radiation oncology self-referral included in President Obama’s Fiscal Year 2015 budget. However, prior authorization for imaging services, also included the FY 2015 budget, is unnecessary and will ultimately raise costs, interfere in the doctor-patient relationship and restrict ready access to imaging care.


Government Accountability Office (GAO) reports have examined self-referral of medical imaging and radiation oncology services and found significant and inappropriate increases in referrals when physicians are allowed to self-refer. This drains Medicare of hundreds of millions of dollars each year.


“Imaging use and associated costs are down significantly since 2006. Only self-referred imaging grew significantly since the middle of last decade. It is past time for government to address self-referral,” said Paul H. Ellenbogen, M.D., FACR, chair of the American College of Radiology Board of Chancellors.


Radiology benefits managers and prior authorization programs take medical decisions out of doctors’ hands, may delay or deny lifesaving imaging and often result in longer waiting times for patients to receive care. A 2011 Moran Co. report found prior imaging authorization would produce no meaningful cost savings, could cost insurers and the government more than it saves and imposes administrative burdens on already strapped physician practices.


“The Sustainable Growth Rate Repeal and Medicare Provider Payment Modernization Act of 2014 would require ordering providers to consult physician-developed appropriateness criteria when prescribing advanced medical imaging studies for Medicare patients,” Ellenbogen said. “This is a far more effective and efficient policy than blanket prior authorization. Electronic ordering systems, based on these criteria, are compatible with hospital electronic health records systems and are shown to reduce duplicate and unnecessary scanning and associated costs without taking decisions out of doctors’ hands or affecting access to care. This approach enjoys bicameral, bipartisan support. We will continue to work with Congress to advance this policy.”


For more information: www.acr.org


Related Content

Guerbet, acquisition, Mallinckrodt, CMDS business, contrast media, CT, MRI
News | Contrast Media| July 29, 2015
Guerbet announced that it has entered into a definitive agreement under which it will acquire Mallinckrodt's contrast...
cardiac rehab after angioplasty, rehabilitation, ACC, Randal J. Thomas, referral
Feature | Cardiac Rehabilitation| July 17, 2015
Hospitals in the Midwest were more likely than others to refer patients for guideline-recommended cardiac...
ACC, health policy statement, heart team, cardiovascular health
Feature | Cardiovascular Surgery| July 17, 2015
Building teams that include advanced practice providers can help cardiovascular practices meet the challenges of modern...
Vital Images, Toshiba, CT Myocardial Perfusion, cardiac CT, CORE 320 study
Technology | July 15, 2015
Vital Images Inc. will debut its U.S. Food and Drug Administration (FDA) 510(k)-cleared CT Myocardial Perfusion...
CMS, physician fee schedule, payment, Sustainable Growth Rate, MACRA, MIPS
News | Business| July 14, 2015
On July 8, the Centers for Medicare and Medicaid Services (CMS) released the first proposed update to the physician...
21st Century Cures Act, H.R. 6, HR-6, HR 6, medical device innovation
Feature | Business| July 13, 2015 | Dave Fornell
The U.S. House of Representatives July 10 passed its version of the 21st Century Cures Act (H.R. 6), designed to...
ICD-9, ICD-10, transition, CMS, AMA, October 1 deadline, guidance
News | Business| July 10, 2015
The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) announced efforts to...
Abiomed, U.S. headquarters expansion, Impella 2.5, RP, jobs
News | Ventricular Assist Devices (VAD)| July 09, 2015
During an event with Massachusetts Gov. Charlie Baker in June, Abiomed announced a major expansion of its U.S....
venture capital funding, VC, healthcare IT, Q2 2015, Mercom Capital Group, IPOs
News | Business| July 09, 2015
Mercom Capital Group llc, a global communications and research firm, released its report on funding and mergers and...
Feature | Business| July 08, 2015
Sorin S.p.A. and Cyberonics Inc. unveiled LivaNova as the name of their combined company, effective at the close of...
Overlay Init