Highmark, beginning in September, will require general practitioners, cardiologists and other providers to request an authorization before performing myocardial perfusion imaging (MPI).
Since April 2006, Highmark said it has required providers to obtain pre-authorization when ordering selected diagnostic imaging procedures, such as MRI, CT and PET.
The payor said it is expanding its program “amid increasing public awareness and scrutiny of the risks of over-exposure to medical radiation.” Highmark cited the July study in the Journal of the American College of Cardiology, led by Jersey Chen, MD, of the Yale University School of Medicine in New Haven. Conn., who at the time noted that with the growing use of cardiac imaging tests with radiation exposure, "clinicians and patients must consider tradeoffs between the benefits of cardiac imaging procedures and their potential long-term risks due to radiation, mainly those of malignancy."
Virginia Calega, MD, Highmark's vice president of medical management and policy, said the radiation dose from an individual MPI study is greater than the radiation dose from many other common diagnostic imaging tests. "Highmark members are undergoing more cardiac imaging tests, especially MPI studies, compared with members of other health plans, increasing the risk of radiation exposure,” she said. “Some Highmark members are undergoing repeat MPI studies over a three-year period."
Highmark also said the expansion is in response to “growing concerns from many of its employer group customers about the appropriateness and the cost of advanced imaging services, in particular cardiac imaging testing.”