ACR Response to GAO Imaging Report: No RBMs Needed
July 15, 2008, Reston, Va. — The American College of Radiology has reviewed the GAO’s report on imaging growth and shares many of the report’s concerns regarding the cost, quality and safety of imaging services. The College agrees with the report’s findings that financial incentives for physicians are a primary driver for the dramatic and costly growth of in-office imaging.
However, the ACR does not support GAO’s recommendations for prior authorization by radiology benefits managers as this process would take medical decisions out of the hands of doctors, may delay or deny lifesaving imaging care to those who need it, and would likely result in longer waiting times for patients to receive care. “Why spend more taxpayer dollars to hire outside entities to examine claims on an individual basis, possibly delaying legitimate exams?” said James H. Thrall, M.D., FACR, chair of the ACR Board of Chancellors. “Concerns regarding image quality, safety and costs should be dealt with directly, not through a third party that will only add more administrative burden on providers.”
Instead of prior authorizations by radiology benefit management companies, the College has been advocating for mandatory accreditation for all providers of advanced imaging services, as well as a demonstration project that will test the use of physician-developed appropriateness criteria. Both of these provisions are included in H.R 6331, the Medicare Improvements for Patients and Providers Act of 2008, recently passed by both Houses of Congress. The College believes these are crucial first steps in dealing with the quality, safety and cost of imaging services.
Currently, there no federally-mandated quality and safety standards for providers of high-tech imaging services such as magnetic resonance imaging (MRI), computed tomography (CT), or positron emission tomography (PET) scans despite the fact that standards established by the Mammography Quality Standards Act have undoubtedly raised the quality of mammograms which have proven to decrease breast cancer mortality.
ACR accreditation would ensure that the physicians supervising and interpreting medical imaging meet stringent education and training standards, that the imaging equipment is surveyed regularly by qualified medical physicists to ensure that it is functioning properly, and that the technologists administering the tests are appropriately certified.
ACR Appropriateness Criteria® help physicians prescribe the most appropriate imaging exam for more than 200 clinical conditions. Implementing Appropriateness Criteria may help address the GAO Report finding that identified the lack of training of many nonradiologists in determining which exam is most appropriate as a factor in increased in-office imaging. The College routinely reaches out to other medical specialties to make them aware of this guidance and encourages them to utilize this important tool. The pilot program called for in the recent Medicare legislation directly deals with this issue and does not take decisions out of the hands of physicians.
“While the ACR certainly supports efforts to reduce the number of unnecessary imaging exams performed in the in-office setting and raise the quality of care provided to patients, the College maintains that the issue should be dealt with directly. Decisions should not be taken out of the hands of physicians. Instead, direct financial incentives for physicians to order more in-office scans should be removed, and quality and safety standards should be instituted to provide for uniform, quality care nationwide,” said Thrall.