Navigation Links
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 (

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.


Contact: Shawn Farley
American College of Radiology

Related medicine news :

1. Society of Interventional Radiology inducts new fellows
2. UCLA cancer researcher wins prestigious Gold Medal from the American College of Radiology
3. Society of Interventional Radiology addresses radiation safety, advances best practices
4. Journal of Vascular and Interventional Radiology debuts new look, reflects global impact
5. Customer representatives mean increased efficiency in radiology
6. Elsevier launches innovative online radiology board review product
7. Virtual colonoscopy and teleradiology bring colorectal cancer screening to patients in rural areas
8. Measuring productivity helps radiology department improve efficiency
9. Virtual Viewbox offers portable radiology access for physicians
10. Journal of Vascular and Interventional Radiology sees growth, promise of tumor ablation
11. Society of Interventional Radiology supports research for new MS treatments
Post Your Comments:
(Date:11/29/2015)... , ... November 29, 2015 , ... Effective immediately, every ... In addition starting on Black Friday Target is offering a “Buy One Scrub Set, ... is a rare opportunity to purchase IguanaMed at a discounted price. , ...
(Date:11/28/2015)... ... ... Safe storage for contraceptive devices may not always be easy to find. However, ... other from Bradley Beach, New Jersey, there is an easy solution to the problem. ... NuvaRings more often than necessary. As such, it affords peace of mind and eliminates ...
(Date:11/28/2015)... ... November 28, 2015 , ... Pixel Film Studios is ... panels to choose from, the possibilities are endless. Users have full control over angle ... ProPanel: Pulse masking effects, users are sure to get heads to turn. , ProPanel: ...
(Date:11/27/2015)... ... November 27, 2015 , ... According to an article published ... Toronto and the University of British Columbia suggested that laws requiring bicyclists to wear ... explains that part of the reason for the controversial conclusion is that, while helmets ...
(Date:11/27/2015)... ... November 27, 2015 , ... A team of Swiss doctors has released a ... Mesothelioma has just posted the findings on the website. Click here to read ... of 136 mesothelioma patients who were treated with chemotherapy followed by EPP surgery. Among ...
Breaking Medicine News(10 mins):
(Date:11/27/2015)... November 27, 2015 Une ... photodynamique au Bremachlorin contre le cancer avancé. ... à combiner l,immunothérapie au traitement photodynamique au Bremachlorin ... Une nouvelle approche consistant à combiner ... cancer avancé.    Clinical Cancer ...
(Date:11/27/2015)... , Nov. 27, 2015  Lannett Company, Inc. ... has completed the acquisition of Kremers Urban Pharmaceuticals ... of global biopharmaceuticals company UCB S.A. (Euronext: UCB). ... Lannett has acquired KU from UCB for total ... adjustments, including a customary working capital adjustment, a ...
(Date:11/26/2015)... , November 27, 2015 ... --> --> ... emergency response system (PERS) market ... for 5 years with APAC ... expected to see a high ...
Breaking Medicine Technology: