ACR, other orgs react to MPFS, HOPPS final rules

CMS released both the Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) final rules for 2016 on Oct. 30, and the American College of Radiology (ACR) issued a separate statement on each rule.

MPFS

The ACR addressed specific parts of the MPFS rule it disagrees with strongly.

“Upon initial review and despite the College's ongoing efforts to advocate for appropriate radiology reimbursement and quality provisions, the ACR is disappointed with some aspects of the rule, including the decision to delay implementation of appropriate use criteria (AUC)/clinical decision support (CDS) and the valuation of low dose lung cancer screening at the same level as non-contrast chest CT,” the statement said.

The ACR had been in favor of the Jan. 1, 2017, deadline for ordering professionals to follow AUC/CDS guidelines, but CMS pushed that deadline back to allow room for additional discussion.

In addition, CMS left low dose lung cancer screening with a value of 1.02 Relative Value Units (RVU), which the ACR disagrees with due to the varying levels of intensity between the two treatments. The ACR has argued against this in the past.

The final rule also stated that CMS is moving forward with implementing the XR-29-2013 standard as of Jan. 1, 2016. The ACR, along with numerous other organizations, had requested a one-year delay in the enforcement of this standard.

The statement also mentioned other less-controversial updates from the rule, including the price of a PACS workstation changing from $2,501 to $5,557 after CMS was able to review submitted invoices.

HOPPS

A lot of the HOPPS final rule focused on shuffling ambulatory payment classifications (APCs), and creating groundwork for the creation of comprehensive APCs, and the ACR summarized many of those updates in its statement.

The HOPPS rule also touched on the upcoming XR-29 standard. Hospitals are to use a “CT” modifier for all scans performed on noncompliant CT equipment, a suggestion first mentioned in the proposed rule, but with little clarification. Again, the ACR had requested a one-year delay in the enforcement of this standard.

Each ACR statement mentions that additional analysis will be available at a later time. Both statements can be found in full on the organization’s website.

Other statements

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) and American Society of Clinical Oncology (ASCO) both issued general statements about the final rules, with the ASCO promising more in-depth analysis in the near future.