Aug 12, 2009 | Laboratory News, Laboratory Pathology
Effort will identify which clinical procedures actually benefit patients—and are cost-effective
“Comparative effectiveness research (CER)” is likely to be one method that healthcare reformers use to establish reimbursement for different medical technologies and treatments. This will apply equally to clinical laboratory testing and pathology professional services as well as other medical procedures.
There is a compelling reason why comparative effectiveness is likely to happen on this turn of the healthcare reform wheel. Congress put teeth into the comparative effectiveness movement earlier this year when it provided $1.1 billion to support the effort in the American Recovery and Reinvestment Act of 2009.
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Aug 7, 2009 | Laboratory News, Laboratory Pathology
MedPAC recommendation targets high-cost imaging done in physician’s offices
Following the lead of some private insurers, Medicare may soon require preauthorization for high-cost imaging tests—including CT, MRI and PET scans—done in physician offices. This is one of two strategies aimed at reducing payments for Part B physician radiology services that was recommended by the Medicare Payment Advisory Commission (MedPAC) in its report to Congress in March.
The General Accounting Office (GAO) estimates that preauthorization could save the Medicare program $220 million by 2014 and about $1 billion by 2019. To make preauthorization work, the Centers for Medicare & Medicaid Services would establish a panel of experts, to be known as a Radiology Benefits Managers (RBMs), to assist in evaluating and adjusting payment for potentially overvalued imaging services ordered by physicians with their own imaging facilities.
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