Prior authorization for imaging not a money-saver

The need to obtain prior authorization for medical imaging exams is costly both from a patient safety and a dollars-and-cents perspective, according to officials from the Access to Medical Imaging Coalition (AMIC). The coalition recently commissioned a new report by healthcare consulting firm The Moran Company to support its case, reports AuntMinnie.com. The report and AMIC's stance contrast recent research that indicates prior authorization saves money over decision support.

Lobbying for an end to prior authorization, AMIC officials said in a press call this week that the practice only winds up delaying patient access to vital scans, thus putting them at greater risk. Tim Trysla, the coalition's executive director, called the practice of prior authorization "unproven" in saving money.

"A prior authorization program would end up costing the government more than it saves and would simply delay patient care and impose administrative burdens and increased costs on physician practices," Trysla said in a statement, according to Kaiser Health News.

Alabama-based doctor Bibb Allen Jr., a member of the American College of Radiology's Board of Chancellors who also was on the call, acknowledged that imaging scans oftentimes are overused. However, he also argued that prior authorization is less about "diagnosis and treatment" and more about "following a money-saving algorithm."

"[W]hat is needed is an approach that curbs inappropriate imaging use rather than all imaging use," he said, according to AuntMinnie.com.

Dr. Andrew Spiegel, CEO of the Colon Cancer Alliance who was on the call, as well, took that sentiment a step further, using patients with colon cancer as an example.

"What's so bothersome is that somebody who doesn't know the patient or the patient's history is making a healthcare decision for this person," Spiegel said. "It interferes with the doctor-patient relationship."

To learn more:
- read this AuntMinnie.com article (reg. required)
- check out this Kaiser Health News piece
- here's The Moran Company's study (.pdf)

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