Advanced diagnostic imaging tools such as MRIs and CT scans have long been posterized as high tech villains responsible for the growth in medical costs. There has always been the implication that they are somehow luxury items that are being prescribed unnecessarily to make money for imaging centers and physicians. In fact, they have been identified as a major contributor to observed increases in life expectancy in the U.S.
Nevertheless, ObamaCare attempts to harshly rein in Medicare expenditures associated with advanced diagnostic imaging. One control method is simply to increase the assumed rate of use of these expensive machines from currently assumed levels. Plugging this arbitrary increase into the Medicare payment formula results in a lower Medicare payment per service to the imaging center. Basically, the high capital cost of the machines is being distributed over a larger assumed patient pool so the payment per patient is reduced.
Of course, if the assumed utilization rate is incorrect, the imaging center may not recoup the cost of the machine. In fact, the CBO identified this as the major downside of this proposal in its December 2008 analysis, noting that this could discourage centers in rural and suburban areas from acquiring advanced imaging equipment. This could result in a shortage of equipment and delays in diagnosis for seniors living in these areas.
A second control measure is the institution of a “prior authorization” policy. Basically, the Government will hire Radiation Benefit Managers (RBMs) to evaluate all imaging requests before they are performed in order to weed out those considered “unnecessary.” The criteria the Government RBMs would use in making their evaluations would be formulated by HHS. The argument for this control measure is very telling – the proponents argued basically that, after all, RBMs are used by private insurance companies.
The same private insurance companies that we were told were evil and greedy? So now we have an evil, greedy, Government making these decisions! And unlike any private insurance company, I see no provision in ObamaCare for making an appeal when a “prior authorization” request for diagnostic imaging is denied.
Also telling is the CBO observation that insurance company experience with instituting “prior authorization” shows that expenditure growth rates are only cut in the beginning of implementation, and resume their upward trend later. Basically, it appears that, initially, doctors are on a learning curve as to how to submit the requests for imaging services, and so many requests are denied. Do you really think it is appropriate for your Government to embrace reduced expenditures that it knows are rooted in the complexities of the “prior authorization” system and which will result in the denial of access to diagnostic tools for many patients during that learning curve period?
So where does all this stand at the present time? A February 14, 2012, article in Molecular Imaging Magazine indicates that HHS has gone forward to implement these cost control measures. You can read it here http://www.molecularimaging.net/index.php?option=com_articles&view=article&id=31966
This article indicates that diagnostic imaging spending/services have been cut back to 2004 levels, and that we can expect a lapse in life expectancy as a result.
Of course, the concept that the ObamaCare bureaucracy could evaluate “prior authorization” requests for diagnostic imaging in a timely manner is ludicrous. Therefore, even the fewer procedures that are eventually approved will be performed later than they should be, resulting in even higher mortality.
I’d like to ask former Speaker Pelosi whether she is now getting a clearer picture of ” ..what’s in the bill” …
Because we certainly are!