Medicare's payment advisory group formally recommended today that the program require prior authorization for some medical imaging services. The first-time suggestion of the Medicare Payment Advisory Commission to add pre-approval to the program came as part of its annual report to Congress on ways to reduce its costs.
MedPAC proposes preauthorization program
Under the proposed prior-authorization program, the CMS initially would compare physicians' use of imaging to identify “outliers” whose use exceeded evidence-based clinical guidelines. If such physicians' imaging use did not decline after a CMS effort to “educate” them, then Medicare would require those clinicians to obtain prior authorization from either the CMS or a contractor.
Alternatively, the panel supported the use of “clinical-decision support systems,” or programs that suggest course treatments based on each patient's data, as long as the system used CMS guidelines and transmitted data to federal administrators.
“This flexibility would help ensure appropriate use of imaging by both self-referring and non-self-referring practitioners without subjecting all providers to prior authorization,” stated Wednesday's report to Congress.
The recommendation followed a 2008 Government Accountability Office report that suggested third-party approval as a way to control the rapid growth of Medicare spending on imaging services. MedPAC reported in March (PDF) that the use of patient imaging in Medicare grew by nearly 10% every year from 2004 to 2008.
Some clinician and patient advocacy groups, along with their congressional allies, have raised strong objections to the idea.
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