Lawmakers urge CMS to reexamine long-delayed imaging Appropriate Use Criteria program
U.S. lawmakers are urging the Centers for Medicare & Medicaid Services to take a fresh look at a long-delayed quality effort following pleas from the medical imaging community.
The Appropriate Use Criteria Program was first established in 2014, requiring docs to consult a support system before ordering MR, CT or other scans. But it has been frequently postponed in the years since, including a recent proposal to push back the penalty phase of the program another year to Jan. 1, 2023.
Imaging advocates such as the American Society of Nuclear Cardiology have asked the feds to indefinitely postpone the program, concerned it’s now outdated and requires retooling. The House Appropriations Committee appears to be listening, asking CMS to examine the quality effort within the next 180 days.
“While the committee recognizes the value of encouraging physicians and other healthcare professionals to consult [appropriate use criteria] and clinical guidelines to support medical decision making, more than seven years have passed since Congress created the AUC program, which has not advanced beyond educational and operations testing,” lawmakers wrote in a report accompanying funding legislation passed on July 15.
In the report, members of Congress also said they want CMS to scrutinize other existing quality improvement programs or payment models and their influence on encouraging appropriate use of advanced diagnostic imaging. They’re asking the agency to consult stakeholders such as professional medical societies in the process.
The nuclear cardiology society called the request an “important milestone” in efforts to convince Congress to reexamine the program. ASNC “pushed for the report language,” it noted, leading an informal coalition of more than 30 medical societies. Beyond being outdated, they also believe AUC is overly prescriptive and duplicative of the Quality Payment Program, heaping unnecessary costs and administrative burdens on physician practices.
“Amidst delays and setbacks, Congress has historically ignored the program and its problems,” ASNC said in a July 19 update to members, adding that action on the spending bill is not expected until the end of 2021.
House Appropriations Committee members also expressed concerns around high lung cancer morbidity and mortality rates and are encouraging CMS to promote CT screening while identifying any barriers. The American College of Radiology said Thursday that it remains “highly engaged” in efforts to establish and promote lung cancer screening programs.
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.