A (Non) Solution in Search of a Problem

The following post was contributed by James A. Brink, MD, FACR, vice chair of the ACR Board of Chancellors.

You may or may not know that the Hawaii Radiological Society, a chapter of the ACR, is working with the Hawaii Medical Association to battle the state’s largest insurer over its advanced imaging preauthorBrink Headshot JPGization mandate.

The two groups say there is no need for preauthorization. The groups also support Hawaii state House Bill 2740, which would, among other things, put the onus on insurers to ensure that care is not delayed by preauthorization.

The College is backing this effort to roll back preauthorization mandates — particularly as imaging use is down considerably nationwide and HHS says there is no independent evidence of preauthorization effectiveness. I recently submitted a letter briefly explaining the ACR position on preauthorization to HIStalk, a website dedicated to health care IT.

Recently, ACR Chief Executive Officer William T. Thorwarth Jr., MD, FACR, affirmed the College’s support of ACR Appropriateness Criteria® through computerized decision support (CDS) tools as a superior to prior authorization.

CDS easily fulfills the requirements of the impending Centers for Medicare & Medicaid Services mandate that will require physicians to consult government- approved, evidence-based appropriate-use criteria when ordering advanced diagnostic imaging exams (CT, MRI, nuclear medicine and PET) for Medicare patients.

I invite you to use the comments section below to share your observations on preauthorization in your area and how you are handling it.

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