ACR: Landmark medical imaging provisions in SGR “patch” to help usher in new era of evidence-based medicine

Washington, DC (March 31, 2014) – What may be first of their kind requirements included in the newly passed  “Protecting Access to Medicare Act of 2014,” (H.R. 4302) would make health care more efficient, raise medical imaging quality, improve utilization accuracy and make physician payment policy more transparent. The American College of Radiology (ACR) applauds the Senate for passing the bill today, and both Houses of Congress, for warding off massive provider payment cuts mandated by the flawed Sustainable Growth Rate (SGR) formula, and taking a landmark step toward modern, evidence-based health care. 

The bill requires ordering providers to consult physician-developed appropriateness criteria when prescribing advanced imaging procedures for Medicare patients. The legislation directs the secretary of the U.S. Department of Health and Human Services (HHS) to identify mechanisms, such as clinical decision support systems, by which ordering professionals can consult these criteria. Such ordering systems reduce duplicate and/or unnecessary scanning and associated costs. This may be the first time that Medicare would require providers to use such point of care, evidence-based ordering for exams or procedures.

“As medical imaging is the cutting edge of modern medicine, this requirement is a major step forward in health care 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,” said Paul H. Ellenbogen, MD, 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.

• Improve patient safety through stricter controls on radiation dose levels delivered by computed tomography (CT) machines.

“The imaging provisions in this bill will help remove the conjecture from health policy regarding how much imaging is necessary, whether patients are getting appropriate care and how efficiently America is using its health care resources. For health care reform to truly advance, physicians, as well as patients, have to be comfortable that transparency works both ways. The imaging provisions in this bill are a major step forward for health care,” said Ellenbogen.

The ACR has concerns regarding the broad statutory expansion of the authority of the secretary of 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. H.R. 4302 now awaits President Obama’s signature to become law.