Automated authorization prevents imaging overuse, saves money

September 11, 2013 in Medical Technology

With profligate use of CT and MRI scans widely blamed for increased healthcare spending, a new report shows that pairing automated prior authorization with evidence-based guidelines can ensure such tests are only used when necessary, improving patient safety while reducing medical costs by perhaps 40 percent.

The recent study, published in September’s Journal of Managed Care Medicine, suggests that automated prior authorization can help put a damper on overuse of such advanced imaging services.

ADVANTAGE Health Solutions, an Indianapolis-based health plan, performed the research as part of a larger study that evaluated the impact of physician engagement on accountable care. It deployed an automated authorization solution developed by Seattle-based MCG (formerly Milliman Care Guidelines), which develops clinical guidelines for the healthcare industry.

“There’s good evidence that advanced imaging services such as CT, MRI, and PET scans are over utilized,” said Anthony N. Akosa, MD, vice president of medical affairs and informatics at AHS, in a press statement.

“This is not just a cost issue,” he added. “It’s also a patient safety and care quality issue, particularly for scans emitting ionizing radiation.”

The AHS study “strongly suggests that pairing automated authorization with evidence-based clinical guidelines” can make for safer and more efficient care, while “also reducing medical costs by 39 percent or more,” he said.

The focus on automated prior authorization is part of larger AHS study aimed at reducing overutilization of emergency room services and expanding use of comparable generics, all within a framework of increased provider and patient engagement. Overall, the report shows such interventions bringing return on investment of eight to one.

“Physician engagement is critical to the success of any program where physicians are accountable for the quality, cost and overall care of an assigned population of patients like an accountable care organization,” wrote Akosa.

“It is well known that physicians control the majority of healthcare cost,” he wrote. “However, as overall healthcare cost is a factor of unit cost and utilization rate of services, physicians could impact utilization of services but still not be able to control overall healthcare cost due to lack of control of cost of hospital-based services and outpatient procedures.”

Other takeaways from the AHS study:

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