Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Radiology benefit managers adversely affect referring physicians, study suggests

01.06.2011
Radiology benefit managers (RBMs) — which provide prior authorization for imaging services using proprietary algorithms to determine appropriateness — shift significant costs to physicians and have the potential to either increase or decrease societal costs, according to a study in the June issue of the Journal of the American College of Radiology (www.jacr.org).

RBMs are widely used by private payers to manage the utilization of imaging services through prior authorization, and they have been proposed for use in the Medicare program. "We created a framework for evaluating the impact of key parameters on the ability of RBMs to lower costs and used decision-analytic modeling to simulate the net impact of RBMs on health care costs under uncertainty from a societal perspective," said David W. Lee, PhD, lead author of the study.

Researchers created a model of a "typical" RBM's prior authorization process and used base-case values for each parameter drawn from published data and the experience of a large, academic institution. As designed, the model predicts that the RBM would have no impact on health care costs.

Under this scenario, RBMs were projected to achieve cost savings of $640,263 through a 12.5 percent reduction in imaging utilization. The model also predicted that these costs savings were offset by RBM fees of $458,197, as well as costs of $182,066 to physicians and their staff members who expended resources complying with RBM procedures. In other words, approximately 28 percent of the total projected savings provided by an RBM are shifted to providers.

"Our analysis demonstrated that RBMs have the potential to either increase or decrease societal costs under a range of plausible assumptions about the parameters that govern their economic impact. We also show that significant RBM-related costs are shifted onto physicians and their staff members who expend resources complying with RBM requirements," said Lee.

"Providers can mitigate the cost shift caused by RBMs by proactively working to ensure that imaging study orders are appropriate. The radiology community can assist in this effort by continuing to improve and expand ACR Appropriateness Criteria® so that physicians who order imaging studies will have better information to guide their decisions, and radiologists can work locally to ensure that appropriate imaging occurs in their communities," said Lee.

The June issue of JACR is an important resource for radiology and nuclear medicine professionals as well as students seeking clinical and educational improvement.

For more information about JACR, please visit www.jacr.org.

To receive an electronic copy of an article appearing in JACR or to set up an interview with a JACR author or another ACR member, please contact Heather Curry at 703-390-9822 or PR@acr.org.

Shawn Farley | EurekAlert!
Further information:
http://www.acr.org

More articles from Studies and Analyses:

nachricht Real-time feedback helps save energy and water
08.02.2017 | Otto-Friedrich-Universität Bamberg

nachricht The Great Unknown: Risk-Taking Behavior in Adolescents
19.01.2017 | Max-Planck-Institut für Bildungsforschung

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Safe glide at total engine failure with ELA-inside

On January 15, 2009, Chesley B. Sullenberger was celebrated world-wide: after the two engines had failed due to bird strike, he and his flight crew succeeded after a glide flight with an Airbus A320 in ditching on the Hudson River. All 155 people on board were saved.

On January 15, 2009, Chesley B. Sullenberger was celebrated world-wide: after the two engines had failed due to bird strike, he and his flight crew succeeded...

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

New technology offers fast peptide synthesis

28.02.2017 | Life Sciences

WSU research advances energy savings for oil, gas industries

28.02.2017 | Power and Electrical Engineering

Who can find the fish that makes the best sound?

28.02.2017 | Information Technology

VideoLinks
B2B-VideoLinks
More VideoLinks >>>