Radiology benefit managers adversely affect referring physicians, study suggests
Radiology benefit managers (RBMs) — which provide prior authorization for imaging services using proprietary algorithms to determine appropriateness — shift significant costs to physicians and have the potential to either increase or decrease societal costs, according to a study in the June issue of the Journal of the American College of Radiology (www.jacr.org). RBMs are widely used by private payers to manage the utilization of imaging services through prior authorization, and they have been proposed for use in the Medicare program. "We created a framework for evaluating the impact of key parameters on the ability of RBMs to lower costs and used decision-analytic modeling to simulate the net impact of RBMs on health care costs under uncertainty from a societal perspective," said David W. Lee, PhD, lead author of the study.
Researchers created a model of a "typical" RBM's prior authorization process and used base-case values for each parameter drawn from published data and the experience of a large, academic institution. As designed, the model predicts that the RBM would have no impact on health care costs.
Under this scenario, RBMs were projected to achieve cost savings of $640,263 through a 12.5 percent reduction in imaging utilization. The model also predicted that these costs savings were offset by RBM fees of $458,197, as well as costs of $182,066 to physicians and their staff members who expended resources complying with RBM procedures. In other words, approximately 28 percent of the total projected savings provided by an RBM are shifted to providers.
"Our analysis demonstrated that RBMs have the potential to either increase or decrease societal costs under a range of plausible assumptions about the parameters that govern their economic impact. We also show that significant RBM-related costs are shifted onto physicians and their staff members who expend resources complying with RBM requirements," said Lee.
"Providers can mitigate the cost shift caused by RBMs by proactively working to ensure that imaging study orders are appropriate. The radiology community can assist in this effort by continuing to improve and expand ACR Appropriateness Criteria® so that physicians who order imaging studies will have better information to guide their decisions, and radiologists can work locally to ensure that appropriate imaging occurs in their communities," said Lee.
Source: American College of Radiology
- Academic medical center finds significant amount of inappropriate CT and MRI referrals from primary care physiciansMon, 1 Mar 2010, 7:15:50 EST
- Embedding images in radiology reports can speed decision making and improve patient careMon, 1 Mar 2010, 7:15:49 EST
- Customer representatives mean increased efficiency in radiologyWed, 12 Jan 2011, 13:33:25 EST
- Side discrepancy errors in radiology reports rare but often clinically significantWed, 20 May 2009, 14:07:41 EDT
- Hospitals encouraged to consider value-added service of hospital-based radiology groupsThu, 1 Sep 2011, 12:40:16 EDT
Articles on the same topic
- Imaging utilization affected by patient age and facility imaging capacity, study suggestsWed, 1 Jun 2011, 5:04:18 EDT
- Imaging utilization affected by patient age and facility imaging capacity, study suggestsfrom PhysorgWed, 1 Jun 2011, 5:00:38 EDT
- Radiology benefit managers adversely affect referring physicians, study suggestsfrom PhysorgWed, 1 Jun 2011, 4:30:54 EDT
Latest Science NewsletterGet the latest and most popular science news articles of the week in your Inbox! It's free!
Check out our next project, Biology.Net
From other science news sites
Popular science news articles
- Detection of the cosmic gamma ray horizon: Measures all the light in the universe since the Big Bang
- Facial-recognition technology proves its mettle
- New filtration material could make petroleum refining cheaper, more efficient
- Heart healthy lifestyle may cut kidney disease patients' risk of kidney failure
- How do cold ions slide