Cardiovascular Business - September/October 2008 - (Page 34) News & Views á RBMs remain divisive in push to decrease imaging costs executive vice president, chief medical officer at Magellan Health Services. Based on the report from the Government Accountability Office (GAO), Sen. Charles Grassley (R-Iowa) introduced legislation to amend the Stark II regulations, which prohibit self-referrals, with some exceptions. Critics of Stark contend that physicians are using the exceptions as loopholes to make money. Grassley’s bill would reologists’ spending on imaging represented the largest share of in-office imaging spending of physician specialties other than radiology. The American College of Cardiology (ACC) supports the Senate bill, and “is supportive of all transparency,” says Patrick Hope, director of legislative policy at ACC. However, the college has questions about some of the data in the GAO report. Hope contends that the GAO relied heavily on a MedPac report from 2005 and the agency needs to consider the financial ramifications of the Deficient Reduction Act (DRA) of 2005, which came into effect in 2007. “We’ve actually seen some data from the American Medical Association, which shows a sharp decrease in the amount of imaging performed directly related to the DRA,” Hope says, adding that the GAO intends to issue future reports on the subject. Dehn, however, refutes the assertion that the GAO was based on old data. “The GAO contacted every organization that is in the business of diagnostic imaging management, including us. We [at Magellan], as well as our competitors, made several formal presentations to GAO, at which time we provided our most up-to-date statistics.” In fact, it was Dehn and his competitors who suggested to the GAO to adopt the RBM model. “We currently use prior authorization on nearly a million of our Medicare members, and the success of that program, along with its return on investment, has been remarkable. There is no evidence to show that we are inappropriately denying services.” Hope, as well as others, criticize RBMs for their lack of transparency and say it is a return to a managed care model, where “people who are not healthcare professionals determine whether a test can be undertaken.” Dehn bristles at that notion, saying that his program never makes a denial unless there is a peerto-peer—physician-to-physician—discussion. In the end, it may be another sector of the government that determines the fate of RBMs. The Department of Health and Human Services commented that the GAO did not conduct “any independent review of the methodology or data used by plans to determine that the use of RBMs was successful or of the manner in which RBMs make their prior authorization determinations.” By Justine Cadet T he notion of radiology benefit managers (RBMs) has always been contentious among certain medical circles. But a recent government report cited the need to rein in Medicare spending on diagnostic imaging, and suggested the Centers for Medicare & Medicaid Services utilize privileging, prior authorization and RBMs. The report also singled-out cardiologists as practitioners who have experienced exponential growth in the use of diagnostic imaging. “Over the last four or five years, there has been a doubling in diagnostic imaging utilization and no apparent change in the health of the population. One has to assume that at least some of the increase is inappropriate, or not contributory,” says Thomas G. Dehn, MD, quire physicians to disclose to patients their financial interest in imaging services to which they might refer; and require physicians to give patients a list of alternative imaging providers in the area. Grassley, citing the GAO report, said that Medicare spending for in-office imaging grew from 58 percent in 2000 to 64 percent in 2006 and that cardi- 34 Cardiovascular Business September/October 2008
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.