Medicare would require prior authorization—for the first time—before clinicians treating beneficiaries could use medical imaging devices, if it followed Thursday's recommendation of the Medicare Payment Advisory Commission. The congressional advisory panel voted 15-1 to recommend that CMS begin requiring prior approval for “practitioners who order substantially more advanced diagnostic imaging services than their peers.”
MedPAC takes aim at imaging overuse
“This is designed in a way that's focused on a very small group of providers on the high end of utilization” of imaging equipment, Scott Armstrong, MedPAC member and president and CEO of Group Health Cooperative, Seattle, said in an interview after the panel's vote.
“Overwhelming” research data in recent years indicated that some providers are overusing imaging equipment far beyond their clinical necessity, he said, including one finding that 10% of providers order 50% of all imaging studies.
Additionally, the panel recommended that Medicare lower payments for successive imaging studies performed in the same session.
In a separate series of votes, MedPAC also recommended a redesign of Medicare's quality improvement organization program. The technical assistance program that aims to help healthcare providers improve care quality would stop funding advisory groups in all 50 states and simply issue direct grants to providers with the same goal.
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