Controlling the escalating use of advanced imaging: the role of radiology benefit management programs.
Since the late 1990s, the use of advanced diagnostic imaging modalities has increased by double-digit rates, outpacing the rate of increase of medical spending overall. In an attempt to assure the appropriate use of advanced imaging procedures, private insurers are increasingly contracting with radiology benefit management programs (RBMs) to reduce overall use and expenditures for radiology services. This article describes the services offered by RBMs and then presents trends in utilization of advanced imaging procedures from three health plans that adopted RBM prior authorization protocols. The implementation of prior authorization protocols by each plan was associated with declines in use of advanced imaging procedures, especially during the first year of the program. Although more rigorous empirical analysis is required in order to draw definitive conclusions, these trends suggest that RBM prior authorization initiatives may be a viable approach for addressing concerns about appropriate use of advanced imaging.
Mitchell
Jean M
JM
Georgetown University, Public Policy Institute, 3520 Prospect St. NW, Room 423, Washington, DC 20007, USA. mitchejm@georgetown.edu
Lagalia
R Robert
RR
D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000191:economics* / Q000706:statistics & numerical data; D019982:Organizational Case Studies; D011872:Radiology Department, Hospital / Q000706:statistics & numerical data; D013675:Technology, High-Cost / Q000706:statistics & numerical data*; D014481:United States