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Controlling the Escalating Use of Advanced Imaging: The Role of Radiology Benefit Management Programs
Jean M. Mitchell*
and
R. Robert LaGalia
* To whom correspondence should be addressed. E-mail: mitchejm{at}georgetown.edu.
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Abstract |
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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.
First published on February 10, 2009, doi:10.1177/1077558709332055
Medical Care Research and Review 2009;66:339.
A more recent version of this article appeared on June 1, 2009
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