This policy basically works by assuming how long the varied equipment is in use, and would affect the technical component of Medicare payments.

It's not totally clear, but it's thought the new plan calls for raising the assumed utilization rate to 90 percent, up from its current 75 percent rate. While the Affordable Care Act was being drafted, Moran said the Obama administration had initially tried to push the 90 percent utilization rate, before both sides compromised at 75 percent, the number included in the final bill. And a similar proposal also appeared in June as a provision attached to a trade bill. (The Office of Management and Budget did not respond to DOTmed News requests for comment on the utilization rate formula by press time.)

Before health care reform passed, the utilization rate was 50 percent, Moran said. She said estimates for the true utilization rate usually fall somewhere between 45 and 55 percent.

Prior authorization

The second bit of the imaging proposal involves pre-authorization. Before ordering an exam on expensive advanced imaging equipment, doctors will first need approval, probably from a radiology benefits management service.

The administration said it was inspired by Government Accountability Office recommendations. But it's also a somewhat tougher implementation of a proposal from MedPAC. In a spring report, the group called for doctors who ordered a high amount of clinically inappropriate advanced imaging tests to first undergo prior authorization. However, unlike that proposal, the current one applies to all doctors, regardless of their resource usage.

The administration says it could save $900 million with the plan over the next 10 years, but ACR disputed those numbers, saying they were likely based on older data, as advanced imaging's growth remains sluggish.

"Any estimates of savings were based on a bottom-line imaging utilization number that was certainly higher in 2008 than it is in 2011," Moran said. "All of advanced diagnostic imaging rates have flattened if not dipped in the last three years."

According to a recent Access to Medical Imaging Coalition report, for instance, advanced imaging is no longer enjoying the wild growth spurt it lived through in the early 2000s. According to the report, advanced imaging procedures grew only one-tenth of one percent from 2008 to 2009.

The ACR also says that some research has suggested the savings might be less than estimated because of the costs of setting up RBMs, and that in any case the costs might fall on providers. For example, a Journal of the American College of Radiology study from June, prepared by an economist with GE Healthcare, estimated that 28 percent of projected RBM savings would actually be shifted onto doctors and their staff.

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