The Medical Imaging and Technology Alliance (MITA) has expressed its support for the health policy goals presented in President Barack Obama's federal budget, but cautions that the budget's proposed reliance on radiology benefit managers (RBMs) will deny imaging services.
It is "an ineffective model that undermines the doctor-patient relationship in making healthcare decisions. If the Medicare program depends on RBMs, it will lead to further reducing seniors' access to life-saving medical services," MITA stated.
MITA said it agreed with the Department of Health and Human Services' (HHS) critique of RBMs, which raised several concerns about the potetntial administrative burden, as well as the advisability of prior authorization for the Medicare program.
"First, the agency said there was no independent data-other than self-reported-on the success of RBMs in managing imaging services. Second, it stated that RBMs' use of potentially proprietary information, including clinical guidelines and protocols for approval of services, may be inconsistent with the public nature of Medicare. Third, the effectiveness of a prior authorization program could be diminished if a high proportion of denied services were overturned through Medicare's statutory and regulatory appeals process. HHS also raised a question about how prior authorization would fit within its current post-payment review program," MITA stated.
"We must ensure that patients have access to the right scan at the right time. The RBM model is the wrong approach and the Administration and Congress should instead build on appropriateness criteria -- a successful approach that was established in last year's Medicare law, and which is used by and proven effective in many of the nation's leading health systems," said Ilyse Schuman, managing director of MITA. "Not only is medical imaging integral to best practices and medical guidelines for disease prevention, early detection, diagnosis and treatment, but research has also demonstrated that imaging technologies both improve health outcomes and reduce healthcare costs when used appropriately.
RBMs, which are currently not regulated, are for-profit managed-care companies that some in health insurance industry use to deny imaging services to patients. Physicians who have operated under an onerous RBM model say that RBMs typically employ insurance actuaries who do not have the medical knowledge necessary to evaluate doctors' requests for images. As a result, RBMs undercut the doctor-patient decisions, lead to inefficiencies and hamper patient care, Schuman noted.