The White House Budget and its effect on Medical Imaging

Although the practice has been around for years, the method of seeking prior authorization for Medical Imaging procedures is still contested by many health care providers. It can lead to possible delays in treatment strategies as physicians and patients try to figure out the correct course of action and wait to hear back from decision makers.

Health Imaging reported that the White House outlined its budget plans for the upcoming 2015 fiscal year and it had all too familiar strategies in place for practices that utilize Diagnostic Radiology, such as cardiology facilities. If the new proposal is passed, the U.S. Centers for Medicare and Medicaid Services will require prior authorization for advanced medical imaging through radiology benefit managers.

Imaging groups react
In response, the Access to Medical Imaging Coalition issued a statement, expressing their concern that the new fiscal plan would interfere with patients’ access to imaging technologies. 

“President Obama’s budget threatens patient access to care and important imaging services through burdensome prior authorization requirements. As an alternative to inserting an artificial middle-man between physicians and their patients via prior authorization schemes, the Administration should follow the lead taken by Congress in crafting a SGR policy which includes the adoption of physician-developed appropriate use criteria. AUC has proven effective in driving appropriate imaging use without compromising patient access to the right scan at the right time,” said Tim Trysla, executive director of AMIC, as quoted by Right Scan Right Time.

According to Diagnostic Imaging, the budget from the Obama Administration also aims to close a loophole in the anti-self-referral law through the elimination of the In-Office Ancillary Services Exception for digital imaging. These new standards were introduced under the pretense that they would facilitate savings in health care, however some organizations feel that the provisions do little to yield substantial reductions in spending, including the American College of Radiology.

“Numerous studies have shown prior authorization increases medical costs and administrative red tape while burdening patients and physicians with potential treatment delays,” the ACR stated, quoted by Diagnostic Imaging.

Appropriate use over authorization
Among medical imaging professionals, the overall industry goal is to reduce the amount of unnecessary imaging procedures and drive down the expenses that go into repeated exams. While it’s admirable that the federal government is attempting to lend a hand to health care spending, the standards in the White House’s proposal will not serve the purposes of improving care quality and cutting spending.

Instead, groups such as the ACR believe that adopting a physician-developed appropriate use criteria would allow providers to better control the ordering of advanced medical imaging technologies. As reported by Health Imaging, combining the criteria with clinical decision support software and an electronic ordering system would increase physicians’ efficiencies more so than prior authorization.

The ACR also provides its own appropriateness criteria on its website, which includes evidence-based guidelines to help physicians determine the correct imaging and treatment decisions for specific conditions. The organization’s materials can help providers enhance the quality of care and bolster the successful use of Digital Radiography.

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