Imaging spending drops, advocates lobby against future cuts

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 - Capitol

The Access to Medical Imaging Coalition (AMIC) has submitted a letter to Congress signed by 22 patient advocacy organizations urging them to protect advanced medical imaging and radiation therapy services against further reimbursement cuts and radiology benefit manager (RBM) and prior authorization proposals.

With eight cuts to medical imaging reimbursements in the past six years, the letter was unveiled during a press conference on Capitol Hill in anticipation that these proposals will be introduced again.

AMIC warned that data indicate patients are undergoing fewer imaging procedures for the second consecutive year. An analysis from the Medical Imaging & Technology Alliance (MITA) found:

  • Imaging utilization per Medicare beneficiary declined by 5.12 percent since 2009;
  • Spending on imaging services for each Medicare beneficiary has dropped 16.7 percent since 2006; and
  • Medicare spending on non-imaging services has grown 21.3 percent since 2006. 

In the letter to Congress, the patient advocacy organizations noted that by impeding access to needed imaging services and undercutting the benefits of early detection, subsequent cuts to Medicare reimbursement will result in greater long-term healthcare spending. Similarly, the use of a prior authorization program has been shown to significantly delay and even deny services to patients without yielding any significant cost savings for taxpayers over the long-term, according to an AMIC press release.

MITA commissioned a Medicare analysis last year that indicated similar declines in utilization and spending on medical imaging services. Since then, the Medicare Payment Advisory Commission has twice confirmed the downward trend and noted in its March report to Congress that imaging represents the slowest growing category in the fee-for-service Medicare program.

In addition, a report by the Patient Advocate Foundation examining 4,360 patient cases involving barriers to imaging access from 2007 to 2011 found that 81 percent of the insurance denials for imaging procedures were due to prior authorization programs.

AMIC urged Congress to support the widespread adoption of evidence-based, physician-developed imaging appropriateness criteria in conjunction with decision support tools to educate physicians.