Industry Background
Radiology benefits management - or RBM - isn't new. National Imaging Associates (NIA) has offered powerful, data-driven solutions to manage radiology benefits since 1995. And today, more than 90 million people are covered by RBM services through commercial, Medicare Advantage, Medicaid, or state health plans.
RBM is one of the most tried and tested evidence-based management programs in the health care industry. This widely used and accepted service has a proven track record of improving patient care and reducing wasteful spending.
Here at NIA, we use RBM to ensure that the most clinically appropriate test is ordered for patients, while providing valuable information to optimize future clinical practice. Through our medical necessity review process, our team of clinical experts offers health care providers a timely second opinion, utilizing physician-developed clinical guidelines and our proprietary algorithms.
How Evidenced-Based Guidelines Are Established
While much of the daily practice of medicine is based on traditional consensus, evidence-based clinical-guideline-development has gained traction by governmental agencies and specialty organizations, such as the American College of Radiology (ACR) since the early 1990s. Practicing medicine with a combination of evidence, technology and knowledge, provides the power to make consistent and medically sound decisions for each patient.
Evidence-based criteria are developed using reliable information derived from respected peer-reviewed studies that are conducted by many individuals and organizations. The elements of true evidence are complex and rigorous, and hold great promise for the wise application of rapidly changing health-related technologies.
NIA imaging appropriateness criteria are reviewed at least annually by medical advisory committees, comprised of radiologists and other medical specialists who practice in academic and community settings. NIA's comprehensive evidence-based guidelines are available online for our customers and providers to reference.
Significant Impact on Patient Health and Safety
Advanced imaging technology offers significant benefits to patients when the technology is used correctly. However, as many as one-third of advanced imaging services are either inappropriate or do not contribute to a physician's diagnosis or the patient's ultimate health outcome.
The inappropriate use of advanced imaging procedures is a health and safety issue for patients - particularly children. Studies have proven that radiation-emitting scans early in life place children at a much higher risk for other health issues and long-term complications, and may often lead to false-positive interpretations that can begin a cascade of unnecessary health care interventions.
RBM addresses these heath and safety issues by managing the clinical appropriateness of advanced imaging tests, to avoid unnecessary radiation for all patients - including children. Through clinical decision support, RBM offers patients numerous benefits, ultimately working to ensure that each patient receives the most appropriate advanced diagnostic imaging procedure. Here at NIA, we go even further by working to raise health care consumer awareness about the risks and benefits of advanced medical imaging.
This is important because radiation exposure is cumulative, and inappropriate use of advanced imaging procedures may result in unnecessarily increasing a patient's risk of developing cancer. While radiation exposure is generally so small that the risk is outweighed by the benefit of having a needed test, unnecessary scans should not be taken lightly.
Every patient has the right to expect the right exam, in the right place at the right time, and RBM works to make that expectation a reality.
Offering Cost Savings to the Health Care System
In addition to the important quality and safety issues addressed by RBM, 15 years of data demonstrate significant health care cost savings.
The value of this historical data cannot be underestimated. As provided by industry leaders like NIA, these services have proven to offer a consistent, convenient, technology-driven, evidence-based solution to escalating imaging costs across all markets and for multiple sectors of the health care industry. This quantifiable evidence has been verified and validated by independent and governmental agencies.While some may argue that passive education and self-monitoring are sufficient to address the documented issues of overutilization, actual data and direct experience do not support this position.
Over the last 15 years, there has been no nationally documented, reliable study that demonstrates that voluntary compliance with evidence-based guidelines for advanced medical imaging services has produced similar measurable results. However, RBM data for commercial, Medicaid and Medicare Advantage programs collected over the same 15-year-period, clearly documents year-over-year cost reductions in the range of 10%-25%.
For more information about the RBM industry and NIA's role in advocating for an outcome-oriented solution to the imaging crisis, visit our Newsroom.