Reimbursement & Patient Access

Further cuts to medical imaging reimbursement will make it more difficult for doctors to detect, diagnose and treat life-threatening conditions.

Reimbursement rates for medical imaging procedures have been slashed 13 times since 2006, which threatens access to needed imaging services and undercuts the benefits of early detection. Protecting access to safe and effective medical imaging technologies is critical to detecting, diagnosing and treating cancers and the many other diseases that affect millions of lives.

Utilization:

Reduced Imaging Reimbursements Harm Care

Additional reimbursement cuts and prior authorization proposals will create more barriers to life-saving medical imaging services that could threaten seniors’ health and well-being. Learn More

Several recent independent analyses have confirmed the recent downward trend in utilization of medical imaging procedures. The Medicare Payment Advisory Commission’s (MedPAC) annual report to Congress in March 2012 confirmed that imaging services declined by 2.5 percent in 2010, while non-imaging utilization increased two percent.   The analysis also found that imaging is now a smaller portion of Medicare spending than it was at the turn of the century.

Imaging Today: Medical Imaging Trends in Medicare
The 2012 MITA analysis of Medicare data finds that medical imaging utilization and spending within Medicare continues to decline, and Medicare patients are receiving fewer imaging procedures for the second year in a row.

Report to the Congress: Medicare and the Healthcare Delivery System
The June 2012 MedPAC report states that in order to maintain access among all beneficiaries, whether rural or urban, Medicare may need to make higher payments to low-volume providers that cannot achieve the economies of scale available to larger providers.

MITA Statement: 2011 MedPAC Data
2011 MedPAC data found that medical imaging spending and utilization has declined within the Medicare program.

Trends in the Utilization of Outpatient Advanced Imaging After the Deficit Reduction Act
Researchers at Thomas Jefferson Medical University found that from 2007 through 2009, there was significant curtailment of growth in CT and MRI, and the rate of nuclear medicine utilization actually decreased.

Radiology Benefits Managers (RBMs) and Prior Authorization Programs:

Prior Authorization: Getting Between Doctors and Patients

Research shows that preauthorization programs for medical imaging services not only create an artificial barrier for patients in need of care but can also lead to significant delays or inappropriate denials of coverage. Learn More

Prior authorization programs require providers to obtain authorization before ordering imaging services, which has been shown to significantly delay and even deny services without yielding any significant cost savings for taxpayers over the long term.

Radiology Benefit Managers (RBMs) are for-profit companies that evaluate physicians’ orders of imaging studies and, using proprietary systems, determine whether to approve or deny the requested service. As a result, patients are often denied the imaging studies their physicians believe are warranted, or are forced to wait days or even weeks to receive them. Such delays and denials can exacerbate patients’ conditions, causing them to need more invasive, intensive and costly treatments down the road.

April 2012 Patient Advocate Foundation Report
An April 2012 study of internal case management data by the Patient Advocate Foundation (PAF) found that 90 percent of the reversed denials were for imaging services that were clearly covered by the patients’ insurance. The study found that it takes a trained professional patient advocate an average of 16 contacts with the insurer before the patient was provided the necessary test.

Prior Authorization: Getting Between Doctors and Patients
A 2012 MITA infographic illustrates that preauthorization programs for imaging services create an artificial barrier for patients in need of care, leading to significant delays or denials of coverage.

Radiology Benefit Managers: Cost Saving or Cost Shifting?
A June 2011 study found hidden costs associated with RBMs and concludes that RBMs actually shift costs onto patients, whose disease may progress while awaiting approval for an imaging procedure, and onto referring physicians, who must spend time seeking approvals and appealing denials.



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