Featured Research

from universities, journals, and other organizations

Radiology benefit managers adversely affect referring physicians, study suggests

Date:
June 1, 2011
Source:
American College of Radiology
Summary:
Radiology benefit managers -- 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 new U.S. study.

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.

Related Articles


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 Criteriaฎ 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.


Story Source:

The above story is based on materials provided by American College of Radiology. Note: Materials may be edited for content and length.


Cite This Page:

American College of Radiology. "Radiology benefit managers adversely affect referring physicians, study suggests." ScienceDaily. ScienceDaily, 1 June 2011. <www.sciencedaily.com/releases/2011/06/110601075134.htm>.
American College of Radiology. (2011, June 1). Radiology benefit managers adversely affect referring physicians, study suggests. ScienceDaily. Retrieved November 26, 2014 from www.sciencedaily.com/releases/2011/06/110601075134.htm
American College of Radiology. "Radiology benefit managers adversely affect referring physicians, study suggests." ScienceDaily. www.sciencedaily.com/releases/2011/06/110601075134.htm (accessed November 26, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Wednesday, November 26, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

From Popcorn To Vending Snacks: FDA Ups Calorie Count Rules

Newsy (Nov. 25, 2014) — The US FDA is announcing new calorie rules on Tuesday that will require everywhere from theaters to vending machines to include calorie counts. Video provided by Newsy
Powered by NewsLook.com
Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Daily Serving Of Yogurt Could Reduce Risk Of Type 2 Diabetes

Newsy (Nov. 25, 2014) — Need another reason to eat yogurt every day? Researchers now say it could reduce a person's risk of developing type 2 diabetes. Video provided by Newsy
Powered by NewsLook.com
Madagascar Working to Contain Plague Outbreak

Madagascar Working to Contain Plague Outbreak

AFP (Nov. 24, 2014) — Madagascar said Monday it is trying to contain an outbreak of plague -- similar to the Black Death that swept Medieval Europe -- that has killed 40 people and is spreading to the capital Antananarivo. Duration: 00:42 Video provided by AFP
Powered by NewsLook.com
Are Female Bosses More Likely To Be Depressed?

Are Female Bosses More Likely To Be Depressed?

Newsy (Nov. 24, 2014) — A new study links greater authority with increased depressive symptoms among women in the workplace. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins