SGR fix good for imaging, but a bad way to make policy

While the passage of the Protecting Access to Medicare Act--which includes a 12-month Sustainable Growth Rate patch and a delay in the implementation of ICD-10--appears to be a good news/bad news proposition for many healthcare organizations, the imaging community is giving it full its full support.

It's easy to see why. The law includes specific provisions for which the imaging community--particularly the American College of Radiology and the Access to Medical Imaging Coalition--has been lobbying; provisions, the ACR said, that will "make healthcare more efficient, raise medical imaging quality, improve utilization accuracy and make physician payment policy more transparent."

The key provision, as far as the imaging community is concerned, requires providers to consult physician-developed appropriateness criteria when prescribing advanced medical imaging procedures for Medicare patients.

"As medical imaging is the cutting edge of modern medicine, this requirement is a major step forward in healthcare reform. Providers will have the latest medical evidence at their fingertips before a scan is ordered, ensuring that patients get the right exam for their condition and avoid unnecessary care. This will reduce unnecessary costs and help pave the way for a more responsive and efficient health care system," Paul Ellenbogen, chairman of the ACR's board of chancellors, said in a statement.

Other provisions supported by the ACR include:

  • A mandate that cuts to medical services greater than 20 percent are phased in over a two-year period
  • One that provides that the Centers for Medicare & Medicaid Services produce data to justify a 25 percent multiple procedure payment reduction for certain imaging exams performed on the same patient, on the same day and in the same session 
  • A provision to improve patient safety by implementing stricter controls on radiation dose from CT machines

The ACR also supports the major provision in the bill--the 12-month SGR patch--as well as the delay in the implementation of ICD-10.

Still, the way in which these pieces of healthcare policy are being handled leaves a bad taste in my mouth.

For a while, it appeared that a permanent bi-partisan solution to the SGR was within reach. But that possibility became increasingly unlikely as the price for a solution became delaying the Affordable Health Care Act's individual mandate.

Then, ICD-10 was thrown into the mix. The latter seemed to hit most medical associations by surprise, and there's been no real explanation how it got in there. As Sue Bowman, senior director of coding policy and compliance for the American Health Information Management Association said, AHIMA and other members of the ICD-10 coalition are "extremely dismayed that this provision was included solely for political reasons--not because it is sound policy."

It's understandable why the ACR supports a temporary fix--as dysfunctional as Capitol Hill is, the 12-month fix might be a good as we're going to get at the moment. It's also understandable that the ACR would support delaying the implementation of ICD-10, since there have been concerns that many radiologists aren't ready for ICD-10.

None of that makes it good public policy, though. - Mike (@FierceHealthIT)

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