The partnership recently received an interesting question from a member and I thought I would share our answer. The member asked:
"Can a physician assistant perform interventional procedures such as fluoro-guided lumbar puncture, CT guided biopsy and drainage, paracentesis, thoracentesis, PICC placement, etc, without physician supervision, so long as they have a radiologic technologist on hand to "step on the pedal" for the X-Ray or CT scan?"
Member Question: Physician Assistant Supervision of Interventional Procedures
A bipartisan group of senators, among them John Kerry (D-MA), Herb Kohl (D-WI), and Lamar Alexander (R-TN), last week sent a letter to the Obama Administration urging the president against any further cuts in Medicare imaging reimbursement. As both political parties seek an agreement to raise the debt ceiling, the timing of the senators' letter is indicative of a growing concern that new cuts to imaging might be part of a final agreement.
The senators highlighted that multiple cuts to imaging reimbursement beginning with 2006's Deficit Reduction Act were already negatively affecting patients' access to life saving advanced imaging technology, and stifling "medical innovation" and job growth in their states (many of the Senators are from states home to medical imaging manufacturers). With further imaging cuts already scheduled for 2012 and 2013, the senators urged President Obama to grant imaging a reprieve and ignore proposals for more reimbursement cuts "in the name of deficit reduction" or to offset future spending.
Senators From Both Sides Oppose Further Imaging Cuts as Part of Deficit Deal
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.