AMIC Says CBO Score Confirms Medicare Should Reject Use of Prior Authorization

Washington, D.C. – The Access to Medical Imaging Coalition (AMIC) today said that the Congressional Budget Office (CBO)’s scoring of President Obama’s FY14 budget confirmed that the use of prior authorization schemes for imaging within the Medicare program would produce no savings and impede Medicare beneficiaries’ access to life-saving imaging services. 

“CBO has confirmed that implementation of a prior authorization program will not only produce zero cost savings, it will insert an artificial barrier between physicians and their patients,” said Tim Trysla, Executive Director of AMIC.  “Seniors rely on medical imaging for early detection and to guide their treatment on the road to survivorship.  Instead of policies that harm patient access without yielding any cost savings to the federal budget, AMIC encourages Congress to advance policies that encourage the appropriate use of medical imaging.”

AMIC has long advocated against the use of prior authorization, such as radiology benefits managers (RBMs). There has been no scientific, peer-reviewed research on the safety, efficacy or impact on administrative costs of prior authorization and RBMs. In fact, empirical analysis of prior authorization and RBM systems in the private sector indicates that roughly 90 percent of RBM denials of coverage for imaging scans are ultimately overturned on appeal. As such, Congress should avoid establishing this type of prior authorization policy that will only create increased administrative complexity for providers and patients, without a measurable benefit for the Medicare program.

Additionally, medical imaging services have borne a disproportionate share of federal cost savings resulting from misguided payment cuts in recent years, with Congress and the Centers for Medicare and Medicaid Services (CMS) slashing Medicare payments for imaging services 12 times in the last seven years. Applying a prior authorization policy in Medicare Fee-for-Service would only add to this inequity and threaten patient access to the early detection and disease management benefits that advanced imaging can provide.

###

The Access to Medical Imaging Coalition represents more than 100,000 physicians, medical providers, and patient organizations throughout the U.S. It also includes health technology firms that manufacture imaging equipment and supplies and that employ tens of thousands of workers. Thus, AMIC represents those who develop medical imaging technologies, those who apply it, and those who benefit from it.