Endocrine Insider
August 21, 2008 

In a report released last month, the Government Accountability Office (GAO) recommended requiring prior authorization to curb the rapid growth of imaging procedures under Medicare Part B. The report was conducted at the request of Senators Jay Rockefeller (D-WV) and Gordon Smith (R-OR) in order to evaluate how imaging services are conducted, paid, and utilized in the Medicare program.

GAO found that Medicare spending for advanced imaging services such as MRI and CT and for standard imaging procedures such as ultrasound and x-ray—including dual energy x-ray absorptiometry (DXA)—increased  from approximately $6.9 billion in 2000 to more than $14 billion in 2006, though growth of advanced imaging rose at a faster rate than that of traditional imaging procedures. Imaging services provided in physician offices increased during the same period from 58 percent to 64 percent of total imaging services. As a result of these findings and after conducting interviews with 17 private health plans, GAO has recommended utilizing practices currently in place in the private market to curtail the growth.

Specifically, GAO recommends that Medicare consider using prior authorization as a means to limit unnecessary imaging procedures. According to the report, several private plans noted that growth in imaging procedures slowed to only 5 percent per year after the implementation of prior authorization requirements. Under the requirements, physicians must obtain some form of approval from the health plan prior to conducting the procedure in order to seek and obtain reimbursement for the service. Currently, CMS does not require prior authorization of imaging services.

Many in the imaging industry are unhappy with GAO's recommendation, stating that the current Medicare system, which requires post-service reviews of the utilization of imaging procedures, is most appropriate given the complexity of patient needs. The Endocrine Society continues to work with a coalition of specialty societies and other medical organizations to oppose proposals that would limit a patient's ability to obtain imaging procedures in a physician's office. To view a letter sent to Sens. Rockefeller and Smith in response to the findings in the GAO report, please click here.

The Society will continue to keep abreast of imaging issues as they arise and to advocate strongly for fair reimbursement for imaging services.

To read the GAO report, please go to http://www.gao.gov/new.items/d08452.pdf.