GAO report ignores key data, says Medical Imaging & Technology Alliance

July, 19, 2008 -- The recently released Government Accountability Office (GAO) report on the growth of imaging services does not provide Congress with suitable recommendations to address medical imaging utilization, claims the Medical Imaging & Technology Alliance (MITA).

"It is disappointing that the GAO report failed to use the most recent data, reference medical guidelines or look at trends in which providers and payers are adopting appropriateness and accreditation criteria to address proper utilization of imaging services," said Andrew Whitman, Vice President of MITA. "As a result, the GAO report obscures how medical imaging utilization decisions are made and the benefit that imaging has to healthcare savings and patient outcomes."

For a more accurate and up-to-date picture of medical imaging Whitman pointed to a recently-released analysis from Avalere Health that demonstrates how the growth of medical imaging services has slowed in recent years. The Avalere Health report examines the most up-to-date Medicare data and also chronicles how medical societies and payers alike are adopting appropriateness guidelines and accreditation criteria to reduce inappropriate scans.

Whitman also said the GAO's analysis of Radiology Benefit Managers (RBMs) was limited and incomplete, lacking examination of how RBM practices, such as prior authorization requirements and provider limitations, impact savings. He also echoed the Department of Health and Human Services' (HHS) concerns that "[i]t does not appear that the GAO conducted 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."

Furthermore, said Whitman, the GAO report did not include comment from medical professional associations nor did it analyze what physicians have said regarding their experiences with RBMs generally, and prior authorization specifically. Rather than assuming that RBMs will resolve concerns about proper utilization, MITA applauds the Members of Congress on both sides of the aisle who instead embraced appropriateness criteria and accreditation in the recently-passed Medicare legislation, as the best approach to ensuring proper utilization, while preserving seniors' access to life-saving diagnostic and therapeutic imaging technologies, he noted.