The House Ways and Means Committee and the Senate Finance Committee have released a draft version of a policy to replace the sustainable growth rate (SGR) formula that includes language requiring that ordering physicians consult appropriateness criteria for advanced imaging services for Medicare patients.
This provision would deny payment for an exam if the ordering physicians fail to consult appropriateness criteria before ordering the exam, and would also require prior authorization for those providers whose ordering patterns aren't consistent with their colleagues.
"This landmark step by Congress is a validation of a cornerstone of the College's imaging 3.0 initiatve that increases quality of imaging care and preserves health care resources. We strongly urge Congress to follow this approach which helps medicine transition from volume-based to quality-based care without interfering in the doctor-patient relationship," said Paul H. Ellenbogen, M.D., FACR, chair of the American College of Radiology Board of Chancellors, in a statement.
The draft language also requires the secretary of the U.S. Department of Health and Human Services to specify appropriateness criteria from among those developed/endorsed by national professional medical specialty societies or other entities. In addition, the secretary is also required to identify appropriateness tools such as clinical decision support (CDS) ordering physicians can consult.
The Medical Imaging & Technology Alliance (MITA) praised the decision to include draft language requiring physicians to consult appropriateness criteria.
"It is critical that policymakers establish physician-developed appropriateness criteria as the benchmark to guide the use of advanced medical imaging services," MITA executive director Gail Rodriguez said in a statement. "Appropriateness criteria, rather than the blunt instrument of across-the-board imaging cuts, is how to root out inappropriate use of imaging."