RBMs could save $24B by 2020

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The implementation of a radiology benefits management (RBM) program could result in significant savings to the Medicare Fee-for-Service (FFS) program, according to a study commissioned by National Imaging Associates (NIA), a subsidiary of Magellan Health Services, and performed by consultants with Milliman, an independent actuarial and consulting firm.

The report, "Potential Savings to Fee-for-Service Medicare from Radiology Benefits Management Programs," projects that RBM programs for advanced imaging services could save between $13 billion and $24 billion by the end of 2020 if implemented in Medicare FFS beginning in 2012.

These findings were extrapolated from actual Medicare Advantage data from 10 health plans and represent a real world estimate that reflects empirical data and the Medicare system of care. The study projected that there will be $121 billion in advanced imaging services covered by fee-for-service Medicare from 2011 to 2020 if current practices remain. Two alternative scenarios that utilize RBMs to manage advanced imaging costs show the potential to save from $13 billion to $24 billion in federal budget expenditures and patient cost sharing.

Key findings of the report include:

  • Without program changes, the total allowed charges associated with advanced imaging services will be approximately $121 billion from 2011 through 2020;
  •  With RBM implemented in Medicare FFS and an assumed impact in only the first year, the savings range from $13 to $17 billion over 10 years; and
  • With RBM implemented in Medicare FFS and an assumed impact that extends to the first and subsequent years through a 50 percent reduction in utilization trend, the savings could range from $20 to $24 billion.

A full copy of the report can be found here.