Radiology must change the payment paradigm for point-of-care ultrasound, experts charge
Point-of-care ultrasound has served as a disruptive innovation in medicine, but terms surrounding this modality continue to be “inconsistent and imprecise.” A group of imaging experts, however, want to upend the POCUS paradigm in a way that could have big implications for reimbursement and care delivery.
Scientists with the Society of Radiologists in Ultrasound and the ACR are proposing a new framework that would divide ultrasound into four separate categories with no overlap, framing POCUS as a completely different type of evaluation from diagnostic ultrasound. Current definitions are too imprecise, and only serve to impair research, payment and accreditation, they explained Tuesday in JACR.
“The distinctions we articulate outline important directions for changing the reimbursement paradigm,” the Mayo Clinic’s Maitray Patel, MD, who serves on the society’s executive board and is a member of the ACR’s Commission on Ultrasound, and colleagues wrote Sept. 29. “The current CPT framework forces the square POCUS peg exclusively through the round hole of ‘diagnostic imaging’ rather than considering and reimbursing POCUS as an inherent component or modifier of an [evaluation and management] service. Moreover, the current framework is severely constrained by not accounting for comprehensiveness in distinguishing among [diagnostic ultrasound] evaluations.”
Patel and his 19 co-authors suggest separating sonographic evaluations into four distinct categories, based on their setting (inside versus outside an E/M service), along with their comprehensiveness and completeness. They say this new framework would move ultrasound payment beyond who performs the exam and more toward what is actually being done. Here is a quick look:
1. POCUS: “Point-of-care ultrasound” would be reserved for sonographic evaluations of a patient performed and reported as part of a patient evaluation and management encounter.
2. NC-DXUS: “Noncomprehensive diagnostic ultrasound” refers to the evaluation with documentation of any number of elements constituting a complete ultrasound (any defined anatomic region or functionally related structures).
3. PC-DXUS: “Partial-comprehensive diagnostic ultrasound,” meanwhile, would cover exams comprehensively evaluating a subset of elements that constitute a complete ultrasound (any defined anatomic region or functionally related structures). Comprehensive evaluation would require use of standard views, protocols and documentation including cine-clip videos.
4. CC-DXUS: “Complete-comprehensive diagnostic ultrasound” would cover comprehensive sonographic evaluations of a full set of elements constituting any defined anatomic region or functionally related structures. Again, comprehensive evaluation would require use of standard views, protocols and documentation including cine-clip videos.
Patel et al. said one important implication from this new framework is that some limited US codes would benefit from reevaluation, distinguishing between noncomprehensive and partial-comprehensive examinations. They also believe their proposal could help incentivize the creation of imaging workflows that reduce effort and costs.
“Profound developments in color Doppler capabilities, cine-clip acquisition and storage, and handheld ultrasound technology have changed the ultrasound landscape; we need a new map,” the team concluded. “Defining POCUS simply as the sonographic evaluation of a patient performed and reported in a patient E/M encounter, and distinguishing DXUS studies on comprehensiveness and completeness, helps crystalize important differences among four major ultrasound categories. We advocate adoption of our proposed categorization system as a framework for providers, researchers, accreditation organizations and payers as they pursue new paradigms.”
Read the entire white paper in the Journal of the American College of Radiology here.
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.