WAUWATOSA, Wis., June 1, 2011 /PRNewswire-USNewswire/ — The
national policy debate on whether Radiology Benefit Managers (RBMs)
should be required for physicians ordering diagnostic imaging tests
for patients is analyzed in a new study appearing in the current
issue of Journal of the American College of
Radiology (JACR). The study indicates that the inclusion
of these third party decision-makers could actually increase cost
to the health care system, largely due to the time consuming
administrative burden incurred by providers.
“The Medicare Payment Advisory Commission – MedPAC
– has recommended that Medicare employ RBMs as a way to lower
utilization and costs,” said David Lee, Ph.D., head of health
economics for GE Healthcare, Americas and senior author of
Radiology Benefit Managers (RBMs): Cost Saving or Cost
Shifting published in the June 2011 issue of JACR.
“However, MedPAC didn’t consider the costs that RBMs impose
on providers who have to expend significant resources complying
with RBM policies and procedures. Our study brings the hidden
costs of RBMs to the forefront.” James V. Rawson, MDb, Sally
W. Wade, MPHc co-authored the study with Lee.
RBMs are hired by health insurance companies to conduct prior
authorization for advanced imaging services such as CT, MRI, PET/CT
and nuclear medicine studies. The use of RBMs is intended to
reduce utilization of imaging services through a variety of
mechanisms, including denial of coverage, diverting patients to
less expensive imaging services, educating physicians about
appropriate imaging and providing physicians feedback about their
image ordering patterns relative to their peers.
The study simulated the impact of RBMs on a private health plan
with 100,000 members and an annual imaging utilization rate of 135
scans per 1,000 members. According to the study analysis,
physicians who order imaging stud