MITA Calls on Congress to Reject Insurance Industry Proposal to Reduce Payments for Life-Saving Imaging Services

Washington, D.C. – The Medical Imaging & Technology Alliance (MITA) today called on Congress to reject the Blue Cross Blue Shield Association’s  (BCBSA) proposal for Medicare to use prior authorization for advanced imaging services.  The proposal was included in a plan that BCBSA submitted to Health and Human Services and Congress.

“A proposal by an association of the health insurance industry to put medical decisions in the hands of the health insurance industry is simply a means to reduce access to medical imaging,” said David Fisher, Executive Director of MITA.  “Medical decisions should remain in the hands of physicians and their patients, rather than the insurance industry.”

There is no peer-reviewed health economic research that shows prior authorization actually produces savings for the Medicare program.  Instead, a recent American Medical Association physician survey found that 63 percent of the 2,400 respondents said that prior authorization delays needed medical procedures.   Additionally, the Department of Health and Human Services (HHS) has already stated that a prior authorization program would be “inconsistent with the public nature of the Medicare program,” due to the lack of transparency and reliance on private companies using proprietary systems to deny physician-prescribed care.  HHS also noted that the Medicare appeals process could overturn a “high proportion” of denials, rendering such a policy ineffective and highly burdensome.

“We know that these programs are highly burdensome and reduce access to care.  Policymakers should not place additional hurdles between patients and necessary diagnostic and screening services,” said Fisher. “Instead, health care providers should use evidence-based, physician-developed appropriateness criteria to ensure patients have access to the right scan at the right time.”