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Study in JACR Finds Radiology Benefit Managers Cost-Savings Benefits Variable

A study in last month's Journal of the American College of Radiology examines the impact of radiology benefit managers' (RBM) preauthorization programs on costs. In theory, RBM-managed preauthorization reduces costs by denying unnecessary exams, shifting to lower-cost exams and simply deterring physician ordering of exams because of the effort required. However, no studies have conclusively determined if these cost-savings outweigh the administrative costs of obtaining preauthorization and the overhead costs to the RBM. Modeling the "typical" preauthorization process, using certain utilization assumptions, the authors examined the impact on overall costs. Under a base -case estimation in which RBMs themselves have no net impact on costs, they found that 28% of RBM costs are shifted to providers. In their model, researchers assumed a hypothetical 100,000-member private health plan with an imaging utilization rate of 135 per 1,000 members per year in estimating the 28 percent cost shift. Overall, in 45% of simulations, RBMs led to cost-savings. But in 95% of cases, the result fell between a savings of $397,880 and cost of $341,991. With results this variable and many contributing factors involved, it seems the jury is still out regarding the impact of RBMs on cost savings overall.