Imaging alliance advocates decision support, not prior authorization
As an alternative to the Medicare Payment Advisory Commission’s (MedPAC) recommendation that practitioners who order high levels of imaging be required to obtain prior authorization, the Imaging e-Ordering Coalition is calling on MedPAC to abandon its recommendation for the time-consuming process and implement clinical decision support.

Following MedPAC’s recommendation last week, the Imaging e-Ordering Coalition, an alliance of providers, companies and associations including the American College of Radiology (ACR), expanded onthe dissent by MedPAC Panel Commissioner Ronald Castellanos, MD, against the committee’s recommendation.
"Rather than relying on prior authorization of care–which some physicians have reported as being inconsistent, resulting in unnecessary delays in treatment, and requiring justification of medical decisions to outside parties not familiar with the patient at hand–we urge MedPAC to take another look at smart technology systems such as clinical decision support tools that are already capable of supporting more efficient, cost-effective and appropriate imaging care," said Liz Quam, co-founder of the Imaging e-Ordering Coalition.

Quam helped lead a three-year pilot of decision support in place of prior authorization, which yielded considerable drops in utilization, costs and time. "By referencing proven imaging clinical decision support systems, physicians are able to quickly and effectively recommend the most appropriate course of treatment for their patient at the point of order, rather than having to rely upon prior authorization in advance of treatment," argued Quam.

"Not only is this approach more efficient for patient care delivery, its provision of immediate clinical feedback and alternative imaging suggestions based on established medical professional society appropriateness guidelines encourages informed decision-making and significantly lowers administrative costs."