Industry bristles at GAOs recommendations to curtail imaging growth

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon

A report issued Monday by the Government Accountability Office (GAO) details the exponential rise in the utilization of CT, MRI and nuclear medicine compared to ultrasound, x-ray and other standard imaging procedures. Critics of the report claim the GAO used outdated data to arrive at its conclusions and take umbrage at the suggestion that physicians need more outside oversight.

The GAO report said that spending on advanced imaging rose 17 percent a year on average compared to average 9 percent annually for more conventional imaging modalities.

But Andrew Whitman, vice president of the Medical Imaging & Technology Alliance (MITA), told Cardiovascular Business 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.

Whitman also faulted the GAO for not examining trends in which providers and payors are adopting appropriateness and accreditation criteria to address proper utilization of imaging services.

“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 said.

He noted a recent analysis from Avalere Health, which 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 recommends that CMS add more front-end approaches to managing imaging services, such as using privileging, prior authorization and radiology benefit managers (RBMs).

Stephen J. Ubl, president and CEO of the Advanced Medical Technology Association, said that the absence of physician assessment or input on the use of RBMs in the report is a glaring omission.

Whitman said that the GAO’s analysis of RBMs was limited and incomplete, echoing the concerns of the Department of Health and Human Services (HHS) that the GAO did not conduct “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.