RBMs, which are currently not regulated, are for-profit managed care companies that some in health insurance industry use to deny imaging services to patients. Physicians who have operated under an onerous RBM model say that RBMs typically employ insurance actuaries who do not even have medical degrees to evaluate doctors' requests for images. As a result, RBMs undercut the doctor-patient decisions, lead to inefficiencies and hamper patient care.

As outlined in its health care reform principles, MITA is a staunch advocate for policies that make health care more accessible, enhance the quality of patient care, reduce inefficiencies and remove barriers to appropriate screenings and treatments. Most recently, MITA proposed and supported the appropriateness criteria and accreditation provisions that were included in last year's Medicare improvement law. These provisions focus on the use of evidence-based guidelines to ensure that medical imaging is utilized appropriately and effectively, without compromising patients' ability to access the right scan at the right time.


"MITA continues to identify and propose policy solutions that will reduce duplicative or unnecessary medical imaging without resorting to blunt policy instruments such as arbitrary, across-the-board cuts to Medicare reimbursements," Schuman said. "Unfortunately, we have already seen the negative effects of ill-informed cuts on patient access in rural areas, making it all the more important to identify sustainable, win-win policies. At this juncture, making further, arbitrary cuts, before existing cuts and reforms such as appropriateness criteria and accreditation are given a chance to work, would be akin to cutting off the nose to spite the face."

According to the Government Accountability Office (GAO), the Deficit Reduction Act of 2005 (DRA) resulted in $1.64 billion in Medicare cuts for imaging services in 2007 alone, the first year cuts were implemented, which was three times larger than what Congress intended. The GAO also found that utilization of advanced imaging services has slowed significantly, which suggests that further cuts could endanger the availability of these services.

MedPAC Recommendations

In another important issue, MITA Urges CMS to Reject MedPAC Recommendation on Medical Imaging. Read their statement:
http://www.medicalimaging.org/Mita/pr030209.pdf

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