Radiology Benefits Management Companies Are the Needed Gatekeepers

July 20, 2011

CT scanners across the country need a gatekeeper. That could be concluded from The New York Times article from June 18, 2011, “Medicare Claims Show Overuse for CT Scanning.” With respect to the “double scans” discussed in this article, neither the physicians requesting these studies nor the doctors performing them at these hospitals made sure that they were performing the right test the right way.

Appropriateness criteria (such as those from the American College of Radiology) and computerized order entry have been advocated as two means of achieving appropriate utilization of advanced medical imaging procedures such as CT. Computerized order entry, however, is still not widely accepted. On the other hand, appropriateness criteria may be a widely accepted notion but not a widely implemented solution, except at the hands of radiology benefits management companies (RBMs). RBMs transfer imaging guidelines from paper to practice.

Employing criteria based on the guidelines of professional societies and the latest literature, RBMs already provide oversight for almost 100 million Americans, guiding their physicians to the right tests at the right times, discouraging the use of inappropriate, unnecessary and redundant studies, including double imaging of the chest. Currently in place and growing in influence, RBMs are the gatekeepers needed to reduce inappropriate utilization and excessive radiation exposure.

Mark D. Hiatt, MD, MBA, MS
Chief Medical Officer
HealthHelp

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