MedPAC recommends prior authorization for high-volume docs

On Thursday, the Medicare Payment Advisory Commission (MedPAC) voted 15 to 1 to recommend that the Centers for Medicare & Medicaid Services require prior authorization before some physicians could order imaging studies.

The recommendation would apply to physicians “who order substantially more advanced diagnostic imaging services than their peers.” MedPAC also recommended lower payments for successive imaging studies performed in the same session.

The recommendations are drawing ire from the radiology community. The Medical Imaging & Technology Alliance (MITA) issued a response, stating, “MedPAC continues to rely on out-of-date data to reach inaccurate conclusions regarding the use of life-saving advanced medical imaging services. Today, while MedPAC finally admitted that imaging utilization is flat, they still approved recommendations to further cut reimbursements to imaging procedures that have experienced significant cuts during the last five years and already face added cuts over the next few years.

“Medicare claims data shows that since 2006 payments for imaging procedures are down significantly and the utilization growth is flat. There are real-world consequences to again imposing reimbursement cuts on these procedures—new innovations don’t come to market, patients lose access to life-saving technologies and people lose their jobs as imaging equipment manufacturing is artificially slowed by short-sighted policy,” MITA stated.