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New Study Questions Ability of Radiology Benefit Managers to Lower Costs
Date:6/1/2011

WAUWATOSA, Wis., June 1, 2011 /PRNewswire-USNewswire/ -- The national policy debate on whether Radiology Benefit Managers (RBMs) should be required for physicians ordering diagnostic imaging tests for patients is analyzed in a new study appearing in the current issue of Journal of the American College of Radiology (JACR).  The study indicates that the inclusion of these third party decision-makers could actually increase cost to the health care system, largely due to the time consuming administrative burden incurred by providers.

"The Medicare Payment Advisory Commission -  MedPAC - has recommended that Medicare employ RBMs as a way to lower utilization and costs," said David Lee, Ph.D., head of health economics for GE Healthcare, Americas and senior author of Radiology Benefit Managers (RBMs): Cost Saving or Cost Shifting published in the June 2011 issue of JACR.  "However, MedPAC didn't consider the costs that RBMs impose on providers who have to expend significant resources complying with RBM policies and procedures.  Our study brings the hidden costs of RBMs to the forefront."  James V. Rawson, MDb, Sally W. Wade, MPHc co-authored the study with Lee.

RBMs are hired by health insurance companies to conduct prior authorization for advanced imaging services such as CT, MRI, PET/CT and nuclear medicine studies.  The use of RBMs is intended to reduce utilization of imaging services through a variety of mechanisms, including denial of coverage, diverting patients to less expensive imaging services, educating physicians about appropriate imaging and providing physicians feedback about their image ordering patterns relative to their peers.

The study simulated the impact of RBMs on a private health plan with 100,000 members and an annual imaging utilization rate of 135 scans per 1,000 members. According to the study analysis, physicians who order imaging stud
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SOURCE GE Healthcare
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