Ben Lauing, Imaging Performance Partnership
President Obama’s proposed budget may signal major reforms in store for imaging. Self-referral, an issue often debated but rarely acted upon, is now an explicit target; the Obama administration has proposed restricting the in-office ancillary services exception to the Stark law. Furthermore, the budget suggests mandatory pre-authorization for advanced imaging modalities.
While this is only a proposed budget, and Congress could take it or leave it, we think it’s highly likely that regulations to curb imaging utilization will soon emerge.
President Obama targets self-referrals and pre-authorization
Eric Bushlow, Imaging Performance Partnership
Policy makers have long argued that the cost of advanced medical imaging among Medicare beneficiaries has contributed significantly to overall health care cost growth. Recent research presented at RSNA 2012, however, suggests the 2005 Deficit Reduction Act (DRA) dramatically impacted the growth of these services as compared to other health care costs.
The study highlights that before the DRA, advanced imaging was the fastest growing service category, ranking in the 86th growth rate percentile in 2001. However, by 2011 advanced imaging fell to the 2nd growth rate percentile—a testament to the effectiveness of this legislation and potentially demonstrating the impact of more recent appropriateness scrutiny.
These findings add to a growing body of evidence suggesting a significant decline in imaging utilization over the past decade—a trend uncovered in the March 2012 MedPAC report.
Growth rate of advanced imaging slows dramatically since DRA
Stephanie Krent, Imaging Performance Partnership
Earlier this summer, the Office of the Inspector General released a new advisory opinion further clarifying the rules surrounding imaging providers' preauthorizations for imaging exams. Largely consistent with previous opinions, the OIG advised that sanctions would not be imposed on the radiology group seeking guidance.
As always, Gregory Demske, the chief counsel to the inspector general, warned that the opinion is limited to the specific facts presented in this case; however, understanding the opinion can help radiology leaders better tailor their own preauthorization processes.
OIG gives green light to radiology group preauthorization