Quality experts urge CMS to fold imaging Appropriate Use Criteria Program into other value initiatives
Healthcare experts with several noted institutions are urging the Centers for Medicare & Medicaid Services to combine the agency’s long-delayed imaging Appropriate Use Criteria Program with other already-running quality efforts.
First established in 2014, the initiative requires physicians to consult a decision-support system before ordering MR, CT and other advanced imaging to help curb healthcare waste. But it’s been plagued by postponements, with CMS most recently pushing the penalty phase back another year, to Jan. 1, 2023.
In a Health Affairs blog published Thursday, quality experts with Johns Hopkins, Harvard and Weill Cornell advocated for potentially folding the AUC program into other similar endeavors. Their request comes after members of Congress in July instructed CMS to reexamine the quality mandate, created seven years ago under the Protecting Access to Medicare Act to curb growing spending on imaging.
“In the years since PAMA was enacted, CMS’ quality initiatives have begun to move the U.S. healthcare system toward value over volume, and toward patients over paperwork,” Andrew Menard, JD, Johns Hopkins Health System’s chief administrative officer—radiology, and co-authors wrote Aug. 26. “As a result, the clinical problem and opportunity for taxpayer savings that motivated Congress to instruct CMS to design and implement the PAMA AUC program have diminished significantly.”
Menard and colleagues suggested folding appropriate-imaging use into the federal agency’s broader Quality Payment Program initiatives. This approach, they wrote, would best serve patients, taxpayers, clinicians and CMS, with the latter recently considering paring down payment models to ease reporting requirements. As a second, “less effective” alternative, Menard and co-authors advised Congress and CMS to simplify PAMA, which they believe will improve the AUC program’s clinical, operational and administrative value.
Physician groups such as the American Society of Nuclear Cardiology (ASNC) have railed against the imaging quality initiative, advocating for its repeal, or a pause for re-examination. In a blog post this month, the society labeled AUC as “complex, administratively burdensome, unnecessary, [and] unworkable.” ASNC has helped lead a coalition of more than 30 medical societies that pushed for lawmakers to authorize a review of the program prior to July’s request from the House Appropriations Committee.
“Congress’ concerns with the AUC program are well-founded, and we suggest that CMS and Congress consider [these] two legislative approaches,” Menard et al. advised.
Others signing the Health Affairs blog included Keith Hentel, MD, a practicing emergency and musculoskeletal radiologist at New York-Presbyterian Hospital/Weill Cornell Medical Center; Ali Raja, MD, MBA, a practicing emergency physician also appointed to the Department of Radiology at Harvard Medical School; David W. Bates, MD, medical director of clinical and quality analysis, information systems for Partners HealthCare System; and Ramin Khorasani, MD, a professor of radiology at Harvard Medical School and Distinguished Chair for Medical Informatics at Brigham and Women’s Hospital.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.