March 31, 2014 — The American College of Radiology (ACR) strongly supports several provisions in the bipartisan “Protecting Access to Medicare Act of 2014,” introduced in the House of Representatives to ward off drastic Medicare provider reimbursement cuts mandated by the flawed sustainable growth rate (SGR) physician payment formula. The college particularly applauds inclusion of several ACR-backed provisions that raise medical imaging quality, enable more efficient care and increase transparency in physician payment policy.
Foremost, the bill would require ordering providers to consult physician-developed appropriateness criteria when prescribing advanced medical imaging procedures for Medicare patients. The legislation would direct the secretary of the U.S. Department of Health and Human Services to identify mechanisms, such as clinical decision support tools, by which ordering professionals could consult these criteria. Such ordering systems are shown to reduce duplicate and/or unnecessary scanning and associated costs.
“The imaging appropriateness criteria provisions in this SGR bill will help ensure that patients get the right exam for the right condition and avoid care they may not need. This would raise quality of care and preserve resources without intruding in the doctor-patient relationship or affecting access to care,” said Paul H. Ellenbogen, M.D., FACR, chair of the American College of Radiology Board of Chancellors.
The ACR also supports provisions in the bill that would:
- Maintain current overall provider reimbursement for the next 12 months (avoiding a 24 percent across the board cut to provider payments statutorily mandated by the SGR formula).
- Mandate that cuts to medical services greater than 20 percent (in comparison to the previous year) are phased in over a two-year period.
- Require the Centers for Medicare and Medicaid Services to produce data used to justify a 25 percent multiple procedure payment reduction, instituted in 2012, to certain imaging procedures provided to the same patient, on the same day, in the same session.
- Delay implementation of controversial ICD-10 provider payment codes as ACR works to prepare radiology providers for the transition to this new system.
“The ACR-backed quality, safety and efficiency measures included in this legislation represent a significant step forward for federal medical imaging policy and medicine in general. This approach represents the state of the art in evidence-based health care. These steps can help restore and maintain the public’s faith that they are getting the best care available for their particular condition in the most effective and efficient manner possible,” said Ellenbogen
However, the ACR has concerns regarding the broad statutory expansion of the authority of the secretary of the U.S. Department of Health and Human Services (HHS) to revalue Medicare physician payments based on a large number of criteria to be used at the secretary’s discretion. The college will continue to work with Congress and HHS to address these concerns.
For more information: www.acr.com