Journal of the American College of Radiology
Volume 7, Issue 1 , Pages 33-38 , January 2010

A Prior Authorization Program of a Radiology Benefits Management Company and How It Has Affected Utilization of Advanced Diagnostic Imaging

  • David C. Levin, MD

      Affiliations

    • Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania
    • HealthHelp, Inc, Houston, Texas
    • Corresponding Author InformationCorresponding author and reprints: David C. Levin, MD, Thomas Jefferson University Hospital, Department of Radiology, Main 1090, Philadelphia, PA 19107
    • ,
  • Robert L. Bree, MD

      Affiliations

    • HealthHelp, Inc, Houston, Texas
    • Department of Radiology, University of Washington Medical Center, Seattle, Washington
    • ,
  • Vijay M. Rao, MD

      Affiliations

    • Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania
    • ,
  • Jean Johnson, MBA, MHA

      Affiliations

    • HealthHelp, Inc, Houston, Texas

References 

  1. Iglehart JK. Health insurers and medical-imaging policy. N Engl J Med. 2009;360:1030–1037
  2. Levin DC, Rao VM, Kaye A. Turf wars in radiology: recent actions against self-referral by state governments, commercial payers, and Medicare—hope is on the horizon. J Am Coll Radiol. 2008;5:972–977
  3. Mathews AW. Insurers hire radiology police to vet scanning. The Wall Street Journal; November 26, 2008;
  4. Congressional Budget Office. Budget options, volume I: health care. http://www.cbo.gov/ftpdocs/99xx/doc9925/12-18-healthoptions.pdfAccessed January 9, 2009
  5. US Government Accountability Office. Medicare Part B imaging services: rapid spending growth and shift to physician offices indicate need for CMS to consider additional management practices. http://www.gao.gov/highlights/d08452high.pdfAccessed September 14, 2008
  6. Senate Finance Committee. Transforming the health care delivery system: proposals to improve patient care and reduce health care costs. http://finance.senate.gov/sitepages/leg/LEG%202009/042809%20Health%20Care%20Description%20of%20Policy%20Option.pdfAccessed May 12, 2009
  7. Office of Management and Budget. A new era of responsibility: renewing America's promise. http://www.whitehouse.gov/omb/assets/fy2010_new_era/a_new_era_of_responsibility2.pdfAccessed May 12, 2009
  8. American College of Radiology. HHS secretary nominee Sebelius questioned regarding medical imaging and radiation oncology. http://www.acr.org/homepagecategories/news/acrnewscenter/hhssecquestionedonimaging.aspxAccessed April 18, 2009
  9. American College of Radiology. ACR Appropriateness Criteria. http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf.aspxAccessed May 18, 2009
  10. Taragin BH, Feng L, Ruzal-Shapiro C. Online radiology appropriateness survey: results and conclusions from an academic internal medicine residency. Acad Radiol. 2003;10:781–785
  11. Brice J. Prior authorization takes command: meet imaging's new decision makers. Diagn Imaging. 2008;30:36–47
  12. Appleby J. The case of CT angiography: how Americans view and embrace new technology. Health Aff. 2008;27:1515–1521
  13. Mitchell JM, LaGalia RR. Controlling the escalating use of advanced imaging: the role of radiology benefit management programs. Med Care Res Rev. 2009;66:339–351
  14. Wiley G. MGH decision-support study: a shot across the RBM bow. http://www.imagingcenterinstitute.com/imagingbiz/volume4_No4/mgh_decision_support_study.phpAccessed April 15, 2009
  15. Jackson DW. The costs of diagnostic imaging: on our radar for 2009. http://www.orthosupersite.com/print.asp?rID=38521Accessed April 22, 2009
  16. Sistrom CL, Dang PA, Weilburg JB, Dreyer KJ, Rosenthal DI, Thrall JH. Effect of computerized order entry with integrated decision support on the growth of outpatient procedure volumes: seven-year time series analysis. Radiology. 2009;251:147–155
  17. American College of Radiology and Radiology Business Management Association. Best practices guidelines on radiology benefits management programs. http://www.acr.org/secondarymainmenucategories/GR_econ/whatsnew/ACRRBMAbestpracticesonRBMPs.aspxAccessed May 4, 2009

 Disclosure: Drs Levin and Bree are consultants to HealthHelp. Ms Johnson is director of health care data analysis at HealthHelp. Dr Rao is a professor and chair of the Department of Radiology at Thomas Jefferson University, which has a contract with HealthHelp to provide peer-to-peer telephone consultations with ordering physicians.

PII: S1546-1440(09)00462-1

doi: 10.1016/j.jacr.2009.09.012

Journal of the American College of Radiology
Volume 7, Issue 1 , Pages 33-38 , January 2010

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