Medicare spending for imaging services paid for under the physician fee schedule more than doubled from 2000 through 2006, increasing to about $14 billion, according to a report issued Monday by the Government Accountability Office (GAO). However, several imaging societies and the Health and Human Services (HHS) Department have criticized the report for using outdated data.
The GAO report said that spending on CT, MRI and nuclear medicine rose 17 percent a year on average, compared to ultrasound, x-ray and other standard imaging procedures, which grew at an average 9 percent annually.
Andrew Whitman, vice president of the Medical Imaging & Technology Alliance (MITA), told Health Imaging News that the GAO predominantly extracted their data from the MedPAC report of 2005, and did not examine the impact of the Deficit Reduction Act (DRA) of 2005. Therefore, the report does not provide Congress with suitable recommendations to address medical imaging utilization, he noted.
“It is disappointing that the GAO report failed to use the most recent data, reference medical guidelines or look at trends in which providers and payors are adopting appropriateness and accreditation criteria to address proper utilization of imaging services,” Whitman said. “As a result, the GAO report obscures how medical imaging utilization decisions are made and the benefit that imaging has to healthcare savings and patient outcomes.”
He also pointed to recent analysis from Avalere Health, which Whitman said used more up-to-date data, and demonstrates medical imaging services growth has slowed in recent years.
To curtail the “rapid growth” of Medicare spending on imaging services, the GAO has recommended that “CMS examine the feasibility of expanding its payment safeguard mechanisms by adding more front-end approaches to managing imaging services, such as using privileging and prior authorization.”
Whitman said that the GAO’s analysis of radiology benefit managers (RBMs) was limited and incomplete, echoing the HHS’ concerns that "[i]t does not appear that the GAO conducted any independent review of the methodology or data used by plans to determine that the use of RBMs was successful or of the manner in which RBMs make their prior authorization determinations." The HHS comments appeared at the end of the GAO report.
“The GAO’s recommendation that CMS rely on a RBM model of prior authorization will create inefficiencies in the healthcare system resulting in seniors being denied access to life-saving diagnostic and therapeutic imaging services,” concurred Tim Trysla, executive director of Access to Medical Imaging Coalition (AMIC).
In conjunction with cardiology and radiology professional societies, HHS should adopt criteria for assessing the appropriate utilization of imaging services, AMIC said.
“Development of appropriateness criteria – not prior authorization -- is an essential step toward ensuring that beneficiaries have access to imaging that best suits their medical conditions,” Trylsa said. “As imaging becomes increasingly integral to best practices in healthcare diagnosis and treatment, it is imperative that physicians and payers agree on which imaging services are appropriate, so that beneficiaries get the right scan at the right time.”