Imaging Coalition Rejects MedPAC Recommendation

The Imaging e-Ordering Coalition is urging the Medicare Payment Advisory Commission (MedPAC) to abandon its recommendation that practitioners who order high levels of imaging be required to obtain prior authorization. An alliance of providers, companies, and associations whose ranks include the American College of Radiology (ACR), the coalition favors the implementation of clinical decision support as an alternative to prior authorization because the latter is a “time-consuming process”.

 Following MedPAC’s recommendation last week, coalition members publicly issued statements expanding on the dissent by MedPAC Panel Commissioner Ronald Castellanos, MD against the committee’s recommendation. "Rather than relying on prior authorization of care–which some physicians have reported as being inconsistent, resulting in unnecessary delays in treatment, and requiring justification of medical decisions to outside parties not familiar with the patient at hand–we urge MedPAC to take another look at smart technology systems, such as clinical decision support tools that are already capable of supporting more efficient, cost-effective, and appropriate imaging care," says Liz Quam, a co-founder of the group.

 Quam helped to lead a three-year pilot of decision support in place of prior authorization, which is said to have yielded considerable decreases in utilization, costs, and time. "By referencing proven imaging clinical decision support systems, physicians are able to quickly and effectively recommend the most appropriate course of treatment for their patient at the point of order, rather than having to rely upon prior authorization in advance of treatment," she asserts.

The coalition contends that not only is decision support more efficient for patient care delivery than prior authorization; it also offers other benefits. Explains Quam: “Its provision of immediate clinical feedback and alternative imaging suggestions based on established medical professional society appropriateness guidelines encourages informed decision-making and significantly lowers administrative costs."