The study is the first of its kind, and it comes at a time when Medicare is considering RBMs as a way to save costs. If a recent recommendation for pre-authorization for high-use referrers were adopted, it would be the first time that Medicare requires pre-authorization for a service.

But congressional proceedings are misconstrued, Lee points out. "There are very few studies that talk about an RBM's ability to actually reduce utilization of imaging," said Lee, who is also head of health economics and reimbursement at GE Healthcare. "Policy makers should understand the full implications of RBMs before they implement it."

In the current medical economy, Ullrich agrees that a macroeconomic perspective is essential. "There's a big picture here," said Ullrich. "We need to look at the macroeconomic framework -- when does it cost more, and when does it produce real tangible savings?"

According to Lee, his framework is not perfect. The researchers were unable to gather much of the necessary data, due in large part to RBMs' unwillingness to share information. The model is also based on assumptions that may not apply to all RBMs since each RBM varies in its policies and procedures.

But despite its limitations, Lee says the model is a crucial first step in understanding the full impact of third-party decision makers like RBMs in the health care system. "We live in this world of evidence-based medicine," said Lee. "But there is still interest in adopting an idea that we know so little about."



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