Medical Imaging Provisions in SGR Bill Improve Quality, Preserve Resources and Make Medicare More Transparent

Washington, DC (Feb. 6, 2014) - The American College of Radiology (ACR) strongly supports the bicameral, bipartisan legislation to replace the flawed sustainable growth rate (SGR) payment formula. The College particularly applauds inclusion of several ACR backed provisions that raise quality of care, make care more efficient 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 studies 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 will raise quality of care and help preserve resources without interfering in the doctor-patient relationship or affecting access to care. We applaud Congress for taking this groundbreaking step,” 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 which would provide a positive payment update of .5 percent to physicians each year through 2018 and require that any specific cuts to medical services greater than 20 percent be phased in over two years.

“Repeated imaging cuts have forced many facilities to close or cut services. According to the FDA, there are now roughly 150 fewer mammography facilities and nearly 600 fewer mammography units available than in 2007. This “dampening” policy would help prevent such massive impact on patient access to care and is a step toward sensible imaging reimbursement policies,” said Ellenbogen.    

Another ACR backed provision would require the Centers for Medicare and Medicaid Services (CMS) to produce data used to justify a 2012 policy that implemented a 25 percent multiple procedure payment reduction to certain medical imaging procedures provided to the same patient, on the same day, in the same session.

“A 2012 JACR study proves that this multiple procedure payment reduction has no basis in fact. CMS has never provided any basis for this destructive policy that affects care for the most sick and injured patients. We look forward to a legislative policy that will force Medicare to justify this cut, which has negatively impacted so many providers,” said Ellenbogen.