CBO Budget Report Confirms No Savings From Imaging Prior Authorization

In its report on the President’s 2014 fiscal budget, the independent Congressional Budget Office (CBO) agreed with the White House that no savings should be anticipated from requiring third-party prior authorization for advanced imaging services — news that gave those opposed to the requirement another opportunity to make their case. According to the ACR, the Obama administration wants third-party prior authorization for the most expensive imaging services because of the Government Accountability Office (GAO) has written favorably about it in the past and because private payors use prior authorization services. In other words, although they list zero dollars as anticipated savings in the budget, they think there might be savings in requiring prior authorization after all because the GAO likes it and private payors use it. Proposals with zero dollars listed next to them as potential savings are unlikely to make it into a final budget, but the Medical Imaging & Technology Alliance (MITA) and the Access to Medical Imaging Coalition (AMIC) both issued releases praising the CBO for not assigning any savings to the proposal. “Research shows that relying on prior authorization programs, such as the use of for-profit radiology benefits managers (RBMs), for advanced imaging increases costs and red tape, placing a burden on physicians,” said Gail Rodriguez, MITA’s executive director, in the official MITA statement. “These programs also create an artificial barrier for patients in need of care, and can lead to significant delays in treatment or inappropriate denials of coverage.” Rodriguez also broadened the scope to issue a reminder that proposals like prior authorization are hardly the only “harmful proposals” that keep being re-introduced to try to curb imaging utilization and that imaging reimbursement has already been cut 12 times since 2006. “As an alternative to these dangerous proposals, MITA urges Congress to adopt policies such as appropriateness criteria that encourage appropriate use of imaging,” she stated. Read the CBO report.View AMIC's reaction.