Medicare GAO Report on Radiology

Prior Imaging-Authorization Suggested

Staff Reporters

As reported in the Wall Street Journal, on July 14, 2008, Medicare may be soon requiring prior authorization to curtail unnecessary utilization of CT scans, MRIs and other forms of medical imaging, a new Government Accounting Office [GAO] report suggests.

The Medicare Report

To cut imaging costs, Medicare has been reducing certain physician payments, sifting through its data to spot improper claims, and educating medical practitioners about the issue. But, the GAO reported that post-payment claims review alone is inadequate to manage medical imaging – one of the fastest growing parts of Medicare – and suggests that Medicare include prior authorization as a possible front-end tactic.

The Findings

The GAO pointed to new evidence of imaging overuse in physician practices, including:

  • The proportion of Medicare spending on in-office imaging rose from 58 percent to 64 percent from 2000 to 2006.
  • Imaging became an increasingly large slice of doctors’ revenue pie. For example, cardiologists got 36 percent of their total Medicare revenue from in-office imaging in 2006, compared with 23 percent in 2000.
  • In-office imaging spending per Medicare patient varied widely nationwide in 2006, from $62 in Vermont to $472 in Florida.

Assessment

What might proponents of the classic Dartmouth Study on healthcare quality say about these findings?

Conclusion

Please comment on the above; opinions from health economists, actuaries and our radiology colleagues are especially welcomed.

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2 Responses

  1. Brain Tumors and Dental Radiology

    Darrell – Did you know that dental X-rays could double the risk for the most common brain tumor, according to a study released Tuesday from scientists and doctors at Yale, Harvard and other prestigious institutions published in Cancer, a scientific journal of the American Cancer Society.

    Mary

    Like

  2. $128 Billion of Radiology Imaging Studies Are Performed Each Year in America
    Unfortunately They Exemplify Healthcare Miscommunication.

    Eric Bricker MD
    via Ann Miller RN MHA

    Like

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