Proposed 2014 Federal Budget Sparks Preauthorization Threat

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The month of April has spawned significant proposals from Congress and the President, with all signs pointing to a hot Summer of negotiations as staffers sort provisions.

A proposal by House Republicans to repeal the sustainable growth rate (SGR) bill aims to connect payments to quality measures, but ACR officials are concerned about the inherent difficulties of evaluating the work of radiologists. “We think it should be the responsibility of the physician community to determine its own standards and metrics,” says Cynthia Moran, assistant executive director of government relations for the American College of Radiology (ACR).

Meanwhile, President Obama’s proposed budget is calling for a preauthorization program for the ordering of certain advanced imaging studies. Moran vows that the ACR will “aggressively fight any approach” that does not incorporate decision support and appropriateness criteria.

“Most physicians do not like a preauthorization program run by radiology benefit managers (RBMs),” she says. “Even though the president’s budget does not specify RBMs, we don’t like that entire direction, and we will be strongly countering any kind of proposal that goes in for preauthorization. We want utilization management strategy adopted by the Congress.”

“Preauthorization is something we have seen before, and it also causes us concern,” adds Gail Rodriguez, executive director of the Medical Imaging and Technology Alliance (MITA). “We do not think that [use of RBMs] is the right way to make decisions about which patients get which scans.”

The other specific proposal in the president’s budget that impacts diagnostic imaging is the closing of the in-office ancillary exceptions list under the Stark rules that would restrict ordering of advanced imaging studies, radiation oncology work, and physical therapy. On this, Moran applauds the president for “trying to close off some of the abuses that have been going on for decades in those services.”