Preauthorization of imaging would only impede patients, doctors

Dan Anderson

The government that says it’s for less government is encroaching again. At issue is Medicare spending on imaging services, which coincides with the booming number of Baby Boomers joining the federal health roll. The latest from the buttinsky bureaucrats is a recommendation from the Government Accountability Office (GAO) that Medicare preauthorize imaging patients just as most private insurers do already.

Those images are expensive, the GAO says, and well-trained doctors may not be the best people to determine whether a patient needs an imaging procedure. Better to leave those decisions—and, therefore, the cost control—to some faceless desk jockey whose medical background amounts to a training day with catered lunch.

The GAO reminds me of that kid in school who knew everything, didn’t mind telling everyone so, and managed in the process to impress the teacher with their alleged omniscience. You knew this kid, too; every class had one.

No matter how ineffective a bureaucracy is, we can add a layer and that will clear it up, is this kid’s argument.

One can just imagine the red tape necessary and the delays encountered trying to get preauthorization for an imaging procedure. Even another agency recognized that much.

The Department of Health and Human Services did the government equivalent of snickering at the class kiss-up, saying what works for private payors may not work so well for Medicare. “CMS would have to consider a more robust set of issues dealing with the advisability of prior authorization techniques that the GAO has recommended before considering their feasibility and the administrative burden,” Assistant Secretary Vince Ventimiglia wrote after reviewing a draft report.

The GAO urged moving forward with a feasibility study, anyway. See what I mean with this kid? Just can’t get through to him.

There’s no doubt that medical care is expensive, and with the growing number of Medicare recipients, the costs will become an even greater burden on federal spending. The government has a responsibility to watch its pennies. They’re my pennies, and I want the government to be prudent with them. But they have to be smart about it. Remember the adage, pennywise and pound foolish.

These decisions should be left in the hands of the patient. Period. Doctors can provide all the information on the pros and cons, risks and potential outcomes, and, yes, the associated costs. But beyond that, the patient has the right—and responsibility—to decide their imaging fate. If they’re responsible for managing the cost of their health care, guaranteed they’ll be prudent, too. After all, they’re grown-ups.

I’ve been having a few conversations with leaders from the industry, talking about ideas for succeeding in the difficult economy, discussing proposed rules, and even doing some industry forecasting. The great thing about these discussions is that you can listen in by visiting our Regulatory Watch Podcast link. They’re all archived there so you can catch up. And they are updated weekly, so you can stay abreast of the latest news and trends. Let me know what you think and offer any suggestions on some topics to discuss in the future.

Dan Anderson
Editorial Director