MedPAC Urged to Reconsider Imaging Reimbursement Cuts

A coalition of medical imaging organizations and patients' advocacy groups asked the Medicare Payment Advisory Commission this week to reconsider its call for reduced reimbursements and required prior authorization for imaging services.

In a letter to MedPAC Chairman Glenn Hackbarth, the Access to Medical Imaging Coalition said the commission's recommendations "would further limit access to life-saving diagnostic imaging services while yielding questionable savings for the Medicare program."

The coalition, which includes dozens of medical imaging groups and professional medical associations, including the American College of Radiology, told Hackbarth it was particularly concerned about MedPAC's call for prior authorization for imaging services.

"Prior authorization has never been used in the Medicare program, impedes patient access to needed care, places huge administrative burdens on providers, and has not been shown to reduce costs over the long term," AMIC said in the letter.

"From the perspective of patient advocates prior authorization would mean placing a barrier between patients and services their physician believes are necessary, which could lead to delayed or denied care. From the provider perspective, prior authorization means having to devote additional uncompensated physician time as well as staff to a burdensome administrative process," AMIC said in the letter.

Nine patients' advocacy groups cosigned the letter with AMIC, including It's My Heart, Colon Cancer Alliance, and Kidney Cancer Association.

Tim Trysla, executive director of AMIC, said in a media release that patients affected by cancers, heart disease, and other illnesses need to be made aware of the potential impact of the MedPAC recommendations.

"Even though MedPAC has acknowledged that the most recent Medicare claims data show that advanced imaging spending and volume are flat, they are recommending further cuts to imaging reimbursement and an unprecedented prior authorization program that would, by definition, impede beneficiaries' access to care," Trysla said.  
Trysla said there is no scientific research validating the clinical quality of radiology benefit managers or whether they truly achieve cost savings or merely shift costs. He said there are numerous peer-reviewed articles supporting the use of advanced imaging studies. "RBMs are not accountable or transparent to the public, and their proprietary algorithms deny or delay care without any peer-reviewed clinical evidence showing they are safe," he said.